Winter is the season to eat persimmons, why can’t you eat persimmons on an empty stomach? Who should eat them more carefully? Why is a giant hairy gastric stone called Rapunzel’s syndrome? Is it possible for an infant who is fed artificially to develop gastric stones? A middle-aged male with abdominal pain and bloating was admitted to the hospital for two days. He was in good health and had no history of abdominal trauma or surgery; he was asked about his medical history and ingested four persimmons (about one and a half pounds) on an empty stomach before the onset of the disease. Emergency laparoscopic exploration was performed, and four dark hard lumps were removed from the terminal small intestine. A diagnosis of intestinal obstruction due to persimmon stones was made. Phytobezoar is the most common type of gastric stone and can occur in all age groups (because fruits such as persimmons can be eaten in all age groups), and disopyrobezoar is the most common type. Persimmons contain a lot of tannic acid and collagen, which, when ingested on an empty stomach, react chemically with gastric acid and mucus to form water-insoluble masses that grow larger and larger as they continue to coat the plant fibers that enter the stomach. Stomach stones in the stomach can cause bloating, abdominal pain, vomiting and other symptoms, and medium-sized stones may fall into the small intestine and cause intestinal obstruction (why medium-sized?). Because small ones do not block the intestine and large ones cannot fall into the intestine), which is the case described above. In addition to persimmons, hawthorn and black dates also contain a lot of tannic acid, which can easily form stomach stones, so these fruits should be avoided on an empty stomach and should not be consumed in excess each time. After major gastrectomy, vagotomy and other patients who affect gastric power and gastric emptying are more likely to develop, there have been reports of such patients using chevron fiber for constipation after the formation of gastric stones needing gastroscopic stone extraction. Such patients should be more cautious in eating the above-mentioned fruits. Phytoliths in the stomach can be treated with lithotripsy and endoscopic stone extraction. Drugs that can be used for lithotripsy include cellulase, papain, acetylcysteine, and Coca-Cola. The carbonic acid and phosphoric acid in cola have a dissolving effect on fibers, and the use of cola to dissolve phytogenic gastric stones has been reported repeatedly. The methods of use include oral administration, gastric tube injection, and gastroscopic perfusion, etc. Some people summarized 46 cases of lithotripsy with cola in 24 papers, of which 23 cases were completely dissolved, and another 19 cases were completely dissolved after combined with endoscopic treatment, with an efficiency of 91. However, the total number of reported cases of cola therapy is small, and large amounts of carbonated beverages may affect pre-existing diseases such as peptic ulcers, so cola lithotripsy should not be used as a first-line treatment, and patients should not try it on their own. If lithotripsy and endoscopic lithotripsy are unsuccessful, or if a gastric stone falls into the small intestine and causes intestinal obstruction, a surgeon will have to be called to surgically remove the stone by laparoscopy or open surgery. Sneak peek at the surgeon: the important thing to note when operating on this type of intestinal obstruction is that there is often more than one stone that has fallen into the small intestine, and care should be taken to carefully explore the stone to avoid missing it. The second type of gastric stone is called hairy gastric stone or trichobezoar, which is caused by swallowing one’s own long hair for a long period of time, mostly seen in young women with anxiety, depression and other psychological disorders (there is a reason why people are shaved in psychiatric hospitals on TV). The hair is difficult to be digested by stomach acid and is kneaded into a ball by the peristaltic action of the stomach and new hair is constantly added, growing larger and larger. Like vegetative gastric calculi, hairy gastric calculi can cause symptoms such as bloating, abdominal pain, vomiting, and weight loss. Large hairy gastric calculi can occupy most of the stomach lumen and protrude into the duodenum, severely affecting the stomach’s digestive and transmission functions. These large, partially protruding hairy gastric stones are also known as Rapunzel syndrome. Rapunzel is the Rapunzel from Grimm’s fairy tale! Perhaps the people before her felt that Rapunzel was locked up alone in a tower for a long time and was prone to depression, plus her extra-long hair made her a high-risk group for huge gastric stones, so they named the disease after her. I wonder if the Brothers Grimm will cry their eyes out when they find out about this. Small hairy gastric stones can be removed by gastroscopy, while large hairy gastric stones, such as the one in Figure 3, will have to be handled by our surgeon. The third type of gastric stone is called a lactobezoar, which is a clot of milk and mucus in the stomach, and occurs in infants under 1 year of age, especially in newborns under 1 month of age. Gastric lactobeles can not only cause abdominal distention, abdominal mass, vomiting, milk clot, weight loss, etc., but also damage the delicate stomach wall of newborns and induce gastric bleeding and gastric perforation, which are serious complications that endanger the life of the child! What are the risk factors for the occurrence of gastric milk stone? There are two main categories: infant’s own factors and feeding factors. Self-factors include: prematurity, low birth weight, etc., which may lead to reduced gastric motility, and dehydration, etc., which may lead to reduced gastric juice secretion and accelerated water absorption. Feeding factors include high protein concentration in the milk or high casein content, both of which can occur only when the baby is not breastfed. High protein concentration is also common when grandparents or grandparents brew milk for their little baby, often wanting their little grandson to drink the thicker the better, fearing that he will not have enough nutrients, and as a result, the concentration is too high and clots in the stomach (not intentionally blacking out the aunts and uncles). The protein concentration of breast milk is only about 1.0g/100, while the protein concentration of milk can be as high as 3g/100g, and the proportion of casein in milk is significantly higher than that of breast milk, which makes it more likely that gastric milk stones will occur. Therefore, if the mother does not have breast milk, she should use formula instead of milk directly, but poor quality formula may still have too much casein, so it is necessary to choose a high quality formula (please contact me if any formula manufacturer needs to insert an advertisement here). In addition, breast milk fortification used for preterm infants may be associated with some gastrolactoliths. For the diagnosis of gastrolactoliths, a detailed feeding history is important, and both abdominal x-ray (contrast is required in some cases) and ultrasound are helpful. If diagnosed promptly, most cases can be treated by fasting, intravenous rehydration and, if necessary, intragastric lavage; combined perforation is an important indication for surgical treatment.