Phytobezoar complicating midgut malrotation

Abstract

A 59-year-old man presented with long-lasting mild epigastric discomfort. He was admitted to our hospital because of epigastralgia and nausea. Computed tomography demonstrated a 65×45 mm mass in the stomach, and endoscopy revealed a phytobezoar. Coca-Cola ingestion softened the stone. Subsequently, we successfully crushed the stone via endoscopy. Component analysis of the stone revealed that the principal element (＞98%) was tannin. In addition, gastroduodenography revealed midgut malrotation. In previous reports, delayed emptying of the stomach and chronic abdominal symptoms have been reported in cases with midgut malrotation. This patient had a history of intake of a large amount of dried persimmon fruit. Therefore, we assumed that the midgut malrotation might have induced delayed gastric emptying and the large intake of persimmon contributed to the formation of the phytobezoar.