Nonpersimmon Gastric Phytobezoar

To the Editor.  —I enjoyed the article by Zarling and Thompson¹ in the May Archives. Several years ago, I encountered a case where a bezoar seemed to be caused by whole orange sections, which prompted my own review of the literature.Oranges are a fairly common cause of nonpersimmon phytobezoars,^2-3 although no clear incidence can be given. Schlung and McHenry² reviewed 84 cases from the literature of small-bowel obstruction in post-gastrectomy patients by orange phytobezoars. The proposed mechanism is that the orange sections can be swallowed with the fibrous pith intact, either by swallowing without completely chewing the segment or by squeezing the juice out of the segments and swallowing the pith. These segments then can reabsorb fluid in the digestive tract. If there is either insufficient acid or insufficient peristalsis to digest the segments, they can cause obstruction. Most of these patients have a history