A 74-year-old woman in Japan developed an intestinal obstruction and perforation after consuming 16 dried persimmons over the course of several days, according to a case study published in the journal Surgical Case Reports, kormedi.com reported.
Abdominal Pain Leads to Emergency Surgery
In January 2023, the 74-year-old patient visited a Japanese hospital reporting abdominal pain and vomiting that started the night before, kormedi.com reported. A computed tomography (CT) scan revealed dilated intestines and twisted blood vessels, prompting surgeons to perform an emergency operation.
During the procedure, doctors extracted a sponge-like mass from the end of the small intestine. The object was dark brown on the outside and orange on the inside. Surgeons removed the mass along with a portion of the small intestine. When medical staff initially asked if she had eaten persimmons—a fruit frequently linked to phytobezoar formation—the patient denied eating any.
Second Obstruction Triggers Realization
The patient resumed eating, but eight days after the initial operation, her bowels obstructed a second time, kormedi.com reported. Doctors suspected another mass from her stomach had migrated downward. They inserted an intestinal tube and attempted to dissolve the blockage using cola injections, but the obstruction persisted, accompanied by a 38.3°C fever.
Thirty days after her first surgery, while being briefed on a second operation, the patient recalled eating 16 dried persimmons over several days roughly three weeks before her symptoms began. On some days, she had consumed three to four pieces a day.
Tannin Bezoar Causes Intestinal Perforation
Surgeons performed a second operation and discovered a small amount of stool in the peritoneal cavity, indicating that a perforation had developed in the small intestine, kormedi.com reported. The tissue showed signs of ulcers and necrosis. Medical staff excised another damaged section of the small intestine.
Laboratory analysis determined that 98% of the extracted mass consisted of tannin, the compound responsible for the astringent taste in persimmons. Tannins react with stomach acid and bind with plant fiber and proteins to form dense phytobezoars. Surgeons diagnosed the patient with a persimmon phytobezoar.
Following the second surgery, the patient recovered and left the hospital 12 days later. She experienced no recurrence during a three-year and two-month follow-up period, kormedi.com reported.
Surgeons Advise Screening for Processed Fruit
Surgeons at Ako City Hospital and Nishiwaki Municipal Hospital emphasized in their published report that clinicians must check for processed foods like dried persimmons, not just fresh fruit, when diagnosing bowel obstructions, kormedi.com reported. They noted that phytobezoars can exist in multiple locations, requiring examinations from the stomach down to the small intestine.
Older adults with dental issues, patients who have undergone gastric resection surgery, and people with diabetes and reduced gastric motility face higher risks because their digestive tracts process food more slowly. Medical teams advise high-risk patients to avoid eating large quantities of dried persimmons at once.
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