SMALL-BOWEL OBSTRUCTION DUE TO CONSUMPTION OF OLEASTER-LEAFED PEAR: A RETROSPECTIVE STUDY

Abstract

Objective: Small-bowel obstruction is a common emergency worldwide. Oleaster-leafed pear (Pyrus elaeagnifolia Pall.) is an endemic wild pear species in Anatolia. The wild pear fruits are consumed for the treatment of diarrhea in traditional medicine. Here, we describe adhesive small-bowel obstruction following consumption of wild pear.

Material and Methods: The medical records of patients who were followed with a diagnosis of adhesion-related small-bowel obstruction between May 2018 and September 2019 were reviewed retrospectively. Patients were divided into two groups as wild pear-related small-bowel obstruction (Group 1) and patients with not wild pear-related small-bowel obstruction (Group 2). Patient characteristics, blood parameters and clinical features were compared between groups.

Results: A total of 74 patients including 16 in Group 1 and 58 in Group 2 were included. The median age in Group 1 and Group 2 was 55 and 60.5, respectively. Increased levels of leukocyte, C-reactive protein, blood urea nitrogen were significantly more frequent in Group 2 (all p<0.05). Group 1 was associated with a shorter duration of complaints and faster recovery (all p<0.05). Surgical intervention was required in only Group 2.

Conclusion: The potential adverse effects of over-consumed traditional medicines should be kept in mind. Questioning the last food consumed before the complaints started may be a clue for food-induced small-bowel obstruction.

Keywords

• adhesive bowel obstruction
• oleaster-leafed pear
• small-bowel obstruction
• traditional medicine
• wild fruit

İğde Yapraklı Armut Tüketimine Bağlı İnce Bağırsak Obstrüksiyonu: Retrospektif Çalışma

Abstract

Amaç: İnce bağırsak obstrüksiyonu dünya çapında yaygın bir acil durumdur. İğde yapraklı armut (Pyrus elaeagnifolia Pall.), Anadolu'da endemik bir yabani armut türüdür. Yabani armut meyveleri geleneksel tıpta diare tedavisi için tüketilmektedir. Bu çalışmada, yabani armut tüketimi sonrası gelişen adheziv ince bağırsak obstrüksiyonunu tanımlıyoruz.

Gereç ve Yöntemler: Mayıs 2018-Eylül 2019 tarihleri arasında adezyona bağlı ince bağırsak obstrüksiyonu tanısı ile takip edilen hastaların tıbbi kayıtları geriye dönük incelendi. Hastalar, yabani armutla ilişkili ince bağırsak obstrüksiyonlu hastalar (Grup 1) ve yabani armutla ilişkisiz ince bağırsak obstrüksiyonlu hastalar (Grup 2) olarak iki gruba ayrıldı. Gruplar arasında, hasta özellikleri, kan parametreleri ve klinik özellikler karşılaştırıldı.

Bulgular: Grup 1'de 16 ve grup 2'de 58 olmak üzere toplam 74 hasta çalışmaya dahil edildi. Grup 1 ve Grup 2'de ortanca yaş sırasıyla 55 ve 60,5 idi. Lökosit, C-reaktif protein, kan üre azotu seviyeleri Grup 2'de anlamlı olarak daha yüksekti (tümü p<0.05). Grup 1, daha kısa şikâyet süresi ve daha hızlı iyileşme ile ilişkili bulundu (tümü p<0.05). Sadece Grup 2'de cerrahi müdahale gerekti.

Sonuç: Aşırı tüketilen geleneksel ilaçların potansiyel yan etkileri akılda tutulmalıdır. Şikayetler başlamadan önce tüketilen son gıdanın sorgulanması, gıda kaynaklı ince bağırsak obstrüksiyonu için bir ipucu olabilir.

Keywords

• adeziv bağırsak obstrüksiyonu
• iğde yapraklı armut
• ince bağırsak obstrüksiyonu
• geleneksel tıp
• yabani meyve

References

1. 1. Catena F, De Simone B, Coccolini F, Di Saverio S, Sartelli M, Ansaloni L. Bowel obstruction: a narrative review for all physicians. World J Emerg Surg. 2019;14:20.
2. 2. ten Broek RP, Issa Y, van Santbrink EJ, Bouvy ND, Kruitwagen RF, Jeekel J et al. Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis. BMJ. 2013;347:f5588.
3. 3. Lohn JW, Austin RC, Winslet MC. Unusual causes of small-bowel obstruction. J R Soc Med. 2000;93(7):365-8.
4. 4. Teng TZJ, Tan YP, Shelat VG. Persimmon fruit causing simultaneous small bowel and stomach obstruction. Singapore Med J. 2019;60(10):550.
5. 5. Slesak G, Mounlaphome K, Inthalad S, Phoutsavath O, Mayxay M, Newton PN. Bowel obstruction from wild bananas: a neglected health problem in Laos. Trop Doct. 2011;41(2):85-90.
6. 6. Silva GJ, Souza TM, Barbieri RL, Oliveira ACD. Origin, domestication, and dispersing of pear (Pyrus spp.). Adv Agr. 2014;2014:e541097.
7. 7. Baytop T. Therapy with Medicinal Plants in Turkey, Past and Present. 2nd ed. Istanbul. Nobel Tıp Kitabevi, 1999.
8. 8. Vilz TO, Stoffels B, Strassburg C, Schild HH, Kalff JC. Ileus in adults. Dtsch Arztebl Int. 2017;114(29-30):508-18.

9. 9. Taylor MR, Lalani N. Adult small bowel obstruction. Acad Emerg Med. 2013;20(6):528-44.
10. 10. Cosse C, Regimbeau JM, Fuks D, Mauvais F, Scotte M. Serum procalcitonin for predicting the failure of conservative management and the need for bowel resection in patients with small bowel obstruction. J Am Coll Surg. 2013;216(5):997-1004.
11. 11. Gans SL, Stoker J, Boermeester MA. Plain abdominal radiography in acute abdominal pain; past, present, and future. Int J Gen Med. 2012;5:525-33.
12. 12. Branco BC, Barmparas G, Schnüriger B, Inaba K, Chan LS, Demetriades D. Systematic review and meta-analysis of the diagnostic and therapeutic role of water-soluble contrast agent in adhesive small bowel obstruction. Br J Surg. 2010;97(4):470-8.
13. 13. Schraufnagel D, Rajaee S, Millham FH. How many sunsets? Timing of surgery in adhesive small bowel obstruction: a study of the Nationwide Inpatient Sample. J Trauma Acute Care Surg. 2013;74(1):181-7; discussion 187-9.
14. 14. Keenan JE, Turley RS, McCoy CC, Migaly J, Shapiro ML, Scarborough JE. Trials of nonoperative management exceeding 3 days are associated with increased morbidity in patients undergoing surgery for uncomplicated adhesive small bowel obstruction. J Trauma Acute Care Surg. 2014;76(6):1367-72.
15. 15. Ten Broek RPG, Krielen P, Di Saverio S, Coccolini F, Biffl WL, Ansaloni L et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg. 2018;13:24.
16. 16. Sajid MS, Khawaja AH, Sains P, Singh KK, Baig MK. A systematic review comparing laparoscopic vs open adhesiolysis in patients with adhesional small bowel obstruction. Am J Surg. 2016;212(1):138-50.
17. 17. Foster NM, McGory ML, Zingmond DS, Ko CY. Small bowel obstruction: a population-based appraisal. J Am Coll Surg. 2006;203(2):170-6.
18. 18. Mehmood MH, Aziz N, Ghayur MN, Gilani AH. Pharmacological basis for the medicinal use of psyllium husk (Ispaghula) in constipation and diarrhea. Dig Dis Sci. 2011;56(5):1460-71.