ABSTRACT
BACKGROUND: Rectal seed bezoars in children seem to present an uncommon problem that necessitates some operative intervention. PURPOSE: Our objective is to determine the occurrence and clinical characteristics of rectal seed bezoars in children with fecal impaction. METHODS: A retrospective review of hospital records of children with discharge diagnosis of fecal impaction was conducted from 1996 to 2005 in a university-affiliated general hospital RESULTS: The study group is composed 59 children. A total of 53 had rectal seed bezoars: watermelon seeds in 43 children, prickly pear seeds in 6, sunflower seeds in 3, and pumpkinseeds in 1. Six children had seedless fecal impaction. All the children with seed bezoars were of Arab origin. Fifty children were treated under general anesthesia. Of the remaining 9 children, 5 underwent digital disimpaction without general anesthesia: 3 with seedless feces and 2 with rectal seed bezoars. Four children with rectal seed bezoars evacuated spontaneously without digital disimpaction. There was summer seasonal preference for watermelon and prickly pear seed bezoars, whereas sunflower seed bezoars occurred in the spring. CONCLUSIONS: Fecal impaction owing to rectal seed bezoars is more common than previously believed. Its occurrence among Arab children alone in this study might indicate a high proportion of fecal seed bezoars throughout the Middle East. We propose that the preferred treatment should include disimpaction and irrigation of the rectal content under anesthesia. Greater awareness by primary care practitioners and parents might be beneficial in its prevention in the future.
Subject(s)
Bezoars/complications , Fecal Impaction/etiology , Rectum , Seeds , Adolescent , Anesthesia, General , Arabs , Bezoars/epidemiology , Bezoars/therapy , Cathartics/therapeutic use , Child , Child, Preschool , Combined Modality Therapy , Comorbidity , Disease Susceptibility , Fecal Impaction/epidemiology , Fecal Impaction/therapy , Feeding Behavior , Female , Humans , Incidence , Israel/epidemiology , Male , Retrospective Studies , Seasons , Species SpecificityABSTRACT
PURPOSE: Seed bezoars in the rectum have been considered an uncommon cause of fecal impaction in adults. Although there have been several reports on sunflower seed bezoars, seed bezoars from the fruit of the prickly pear cactus and watermelon have received little notice. This study was designed to determine the frequency of fecal impaction by seed bezoars in the rectum and their clinical characteristics in adults. METHODS: A retrospective review of the medical records of patients hospitalized with the diagnosis of fecal impaction during a ten-year period. RESULTS: During the study period (January 1996 to December 2005), 55 patients were hospitalized at the Western Galilee Hospital, in northern Israel, with the diagnosis of fecal impaction. Phytobezoars were found in 30 patients (55 percent). The seed bezoars were composed of prickly pear seeds in 12 patients, watermelon seeds in 10 patients, sunflower seeds in 4 patients, popcorn kernels in 1 patient, and pomegranate seeds in 1 patient. The Jew:Arab ratio for seed bezoars was 7:23. Seventy-three patients had seedless fecal masses with a Jew:Arab ratio of 58:15. All 30 patients with bezoar underwent digital disimpaction under general anesthesia. Only 21 of 73 patients with seedless fecal masses were treated under general anesthesia. CONCLUSIONS: Seed bezoars found in the rectum were the most common cause of fecal impaction requiring hospitalization, probably to the result of the eating habits in the Middle East. The consumption of seeds with shell fragments or fruits containing many seeds (such as the prickly pear) should be accompanied by the awareness that large quantities may cause fecal impaction.
Subject(s)
Bezoars/complications , Fecal Impaction/etiology , Rectum , Seeds/adverse effects , Adult , Aged , Citrullus , Fecal Impaction/therapy , Female , Humans , Male , Middle Aged , Opuntia , Retrospective StudiesABSTRACT
La esquizofrenia es una enfermedad que afecta aproximadamente al 1 por ciento de la población mundial. Es una de las enfermedades psiquiátricas más debilitantes con un alto costo económico, social, familiar y personal. En Costa Rica, la esquizofrenia constituye la primera causa de internamiento entre los desórdenes psiquiátricos en el Hospital Nacional Psiquiátrico. El presente estudio analiza el diagnóstico preliminar de los primeros 120 pacientes incluidos en el proyecto sobre la Genética de la Esquizofrenia. Al comparar el diagnóstico del entrevistador, el diagnóstico final por consenso y el diagnóstico del último egreso hospitalario se encontraron diferencias en alrededor del 40 por ciento de los sujetos en el estudio. Se encontró un relativo sub-registro de la sintomatología afectiva en los diagnósticos de egreso con el consecuente sobre-diagnostico de los trastornos esquizofrénicos en los hospitales nacionales. El trastorno esquizoafectivo fue uno de los diagnósticos con menor concordancia. Las diferencias diagnósticas encontradas pueden ser parcialmente explicadas por el uso de pautas la clínica. Sin embargo, la concurrencia de diferentes síntomas en las enfermedades psiquiátricas severas y las limitaciones impuestas por la categorización diagnóstica, obliga al psiquiatra a encasillar al paciente en una categoría que puede no representar completamente la enfermedad de ese paciente. El encontrar con marcadores biológicos en un futuro podría servir para clasificar estos síndromes en entidades diagnósticas más precisas, a explicar la fisiopatología de estas enfermedades y mejorar el tratamiento. Palabras clave: Esquizofrenia, pautas diagnósticas.
