Etiological aspects of intragastric bezoars and its associations to the gastric function implications: A case report and a literature review

Case Report on Rapunzel syndrome: a large gastric trichobezoar extending to the proximal jejunum in a young adult female

A trichobezoar is an intraluminal mass of hair growing continuously with additional ingestion, while Rapunzel syndrome refers to a giant gastric trichobezoar that extends from the stomach into the small intestine. We present a case of Rapunzel syndrome as an uncommon cause of upper gastrointestinal (GI) symptoms in a young adult woman who denied trichotillomania and trichophagia. Preoperative radiological assessment was pivotal in planning a preferable therapeutic approach. The patient underwent laparotomy and prepyloric gastrotomy, resulting in satisfactory postoperative outcomes. Trichobezoars are extremely rare and predominantly affect young women with underlying psychiatric conditions. Although uncommon, they cause severe upper gastrointestinal symptoms and may even lead to various complications. This case report helps in understanding the presentation of gastric trichobezoar and Rapunzel syndrome, including their range of symptoms, radiological appearance, and associated findings, to make an accurate diagnosis and guide an appropriate treatment approach.

Small intestinal obstruction caused by the gastric bezoars in elderly diabetic patients: A case report

INTRODUCTION

Bezoar is an unusual cause of small bowel obstruction accounting for 0.4-4 % of all mechanical bowel obstruction. With the rising incidence of diabetes and the associated risk of gastrointestinal issues.

CASE PRESENTATION

A 59-year-old female diabetic patient with no prior surgical history presented with severe nausea, vomiting, and abdominal pain. CT scan revealed dilated small bowel loops, and endoscopy showed gastric retention with an impacted fecalith in the descending duodenum. At exploratory laparotomy, a bezoar was found impacted in jejunum 5-6 in. away from the Treitz ligament and was removed through an enterotomy.

CLINICAL DISCUSSION

The discussion highlights the rarity of bezoar-induced small bowel obstruction and the diagnostic challenges it presents. Despite its low incidence, it is essential to consider phytobezoars in the differential diagnosis of small bowel obstruction, especially in middle-aged to older adult diabetic patients. The case underscores the importance of a detailed patient history and the use of imaging modalities such as computed tomography (CT) for accurate diagnosis. Early intervention is critical to prevent serious complications like bowel ischemia or perforation. When conservative treatments are ineffective, surgical intervention becomes necessary.

CONCLUSION

Bezoar-induced small bowel obstruction remains an uncommon diagnosis. A detailed patient history and appropriate imaging are vital for timely diagnosis. It should be suspected in patients with an increased risk of bezoar formation, such as in middle-aged to older adult diabetic patients or a history suggestive of increased fiber intake. CT scan is helpful for preoperative diagnosis. and highlights the need for increased awareness among clinicians regarding the management of bezoars.

Tennis ball cord combined with endoscopy for giant gastric phytobezoar: A case report

BACKGROUND

Due to the specificity of Chinese food types, gastric phytobezoars are relatively common in China. Most gastric phytobezoars can be removed by chemical enzyme lysis and endoscopic fragmentation, but the treatment for large phytobezoars is limited, and surgical procedures are often required for this difficult problem.

CASE SUMMARY

For giant gastric phytobezoars that cannot be dissolved and fragmented by conventional treatment, we have invented a new lithotripsy technique (tennis ball cord combined with endoscopy) for these phytobezoars. This non-interventional treatment was successful in a patient whose abdominal pain was immediately relieved, and the gastroscope-induced ulcer healed well 3 d after lithotripsy. The patient was followed-up for 8 wk postoperatively and showed no discomfort such as abdominal pain.

CONCLUSION

The combination of tennis ball cord and endoscopy for the treatment of giant gastric phytobezoars is feasible and showed high safety and effectiveness, and can be widely applied in hospitals of all sizes.

Meat bezoar due to inadequate mastication leading partial bowel obstruction: A case report

INTRODUCTION

Gastrointestinal bezoars may occur in individuals with a normal gastrointestinal tract structure or as a result of gastrointestinal defects and disease. This rare condition initially presents with general abdominal pain, mimicking appendicitis in later stages. Recognizing this condition as a differential diagnosis in patients with abdominal pain can prevent delays in diagnosis and serious complications.

PRESENTATION OF CASE

We report a rare case of a meat bezoar in a 52-year-old man presenting with acute and generalized abdominal pain at an emergency department.

DISCUSSION

We discuss gastrointestinal bezoars as a rare differential diagnosis of abdominal pain and acute abdomen in people with no pre-existing medical history, and the challenges that might be faced during diagnosis and treatment.

CONCLUSION

Gastrointestinal bezoars are rare which makes the diagnosis challenging. Obtaining a complete history and a full examination with appropriate imaging could help the diagnosis.

All Tangled Up: Meter-Long Gastric Trichobezoar Causing Multiple Intussuscepting Points in an Adult

Gastric trichobezoars are a result of trichophagia secondary to trichotillomania, and can result in severe complications such as perforation or intussusception. We present the case of a 19-year-old female with multiple points of intussusception secondary to a large gastric/small intestine trichobezoar and describe our approach to diagnosis and eventual removal of the bezoar.

The Neurology and Psychopathology of Pica

PURPOSE OF REVIEW

Pica is defined by the American Psychiatric Association's Diagnostic and Statistical Manual, 5th edition (DSM 5) as the ongoing ingestion of materials with no nutritive or food value. More specifically such ingestions must be unremitting for at least 1 month and occur at a developmentally inconsistent age for such behavior. This article reviews the association of pica with pregnancy, micronutrient deficiencies, psychiatric disorders, dementia, and developmental disorders with emphasis on autism spectrum disorders (ASD).

RECENT FINDINGS

Some variants of non-nutritive consumption are prevalent behavioral norms in non-western cultures, so not all picas should be considered pathological. However, the strong association of pica with iron deficiency anemia (IDA) lends credence to the hypothesis that dopamine transmission may be disrupted in this disorder. Picas associated with ASD are resistant to medications but can be treated with applied behavioral analysis therapy (ABA). Etiological hypotheses for pica are explored with a focus on neurobiological, neuroimaging, and psychiatric correlations. Pharmacological management and behavior modification strategies are also discussed. The possibility that pica is a form of addiction analogous to food cravings is introduced and suggested as an area for further research pursuits.

Management of trichobezoar: About 6 cases

BACKGROUND

Trichobezoar is an uncommon clinical entity in which ingested hair mass accumulates within the digestive tract. It is generally observed in children and young females with psychological disorders. It can either be found as an isolated mass in the stomach or may extend into the intestine. Untreated cases may lead to grave complications.

MATERIAL AND METHODS

We retrospectively analyzed the clinical data of six patients treated for trichobezoar in Monastir pediatric surgery department during 16-year-period between 2004 and 2019. Imaging (abdominal computed tomography and upper gastroduodenal opacification) and gastroduodenal endoscopy were tools of diagnosis.

RESULTS

Our study involved 6 girls aged 4 to 12. Symptoms were epigastric pain associated with vomiting of recently ingested food in 3 cases and weight loss in one case. Physical examination found a hard epigastric mass in all cases. The trichobezoar was confined to the stomach in 4 cases. An extension into the jejunum was observed in 2 cases. Surgery was indicated in all patients. In two cases, the attempt of endoscopic extraction failed and patients were then operated on. All patients had gastrotomy to extract the whole bezoar even those with jejunal extension. Psychiatric follow-up was indicated in all cases. The six girls have evolved well and did not present any recurrence.

CONCLUSION

open surgery still plays a crucial role in Trichobezoard management . After successful treatment, psychiatric consultation is imperative to prevent reccurrence and improve long term prognosis.

Acute Cholecystitis Masking a Gastric Bezoar

A bezoar is a solid mass of indigestible material that usually forms in the gastrointestinal (GI) tract. Gastric bezoars, located in the stomach, can present variably. They can be asymptomatic or present with GI symptoms like nausea, vomiting, abdominal pain, or more serious complications, such as GI obstruction or perforation. Diagnostic modalities are mainly radiological, and treatment may either be conservative or interventional. Herein, we disclose the case of a 47-year-old female who presented with a two-week history of abdominal pain with an incidental finding of a possible gastric phytobezoar, co-existing with gallbladder disease. Although not previously reported, this study highlights the possibility of an association between gallbladder disease and the formation of a bezoar.

The differential for chest pain: when the most common cause is not the answer-a case of de novo esophageal bezoar

Background

Having a broad differential and knowing how to manage the different possibilities in a patient with chest pain is important. Esophageal bezoars are rare entities and are even less common in patients without any recent hospitalizations, known achalasia, or nasogastric tubes. Despite their rarity, having it in one’s differential, and knowing how to manage it is important.

Case presentation

This case presents a patient with mega-esophagus secondary to an esophageal bezoar; and runs through the gamut of morbid chest pathophysiology, its differential, work-up, and management. The case is interesting in that the patient’s initial presentation brings to mind a bevy of feared chest issues to include myocardial infarction, dissection, pulmonary embolus, achalasia, and perforation.

Conclusion

This clinical case highlights more than just the rare diagnosis of esophageal bezoar. It also goes through initial resuscitation, key concerns, “can’t miss diagnoses”, and finally discusses the feared end state of an esophageal perforation.

Bezoar: an uncommon cause of upper gastrointestinal bleeding

Bezoars are aggregates of non-digestible material that accumulate in the gastrointestinal tract. They can be classified according to their composition, and phytobezoars (composed of vegetable or fruit fiber) is the most common type. They most often occur in patients with some risk factors, namely prior gastric surgery, neuropsychiatric, endocrine or other disorders that lead to abnormal gastric function, or poor gastric peristalsis. Bezoars may be asymptomatic but most commonly cause abdominal discomfort or pain, nausea, vomiting, fullness, difficulty in swallowing, or anorexia and weight loss. Upper GI endoscopy for both diagnostic and therapeutic purposes is key in the management of bezoars.

Risk factors, endoscopic findings, and treatments in upper gastrointestinal bezoars: multi-center experience in Iran

AIM

The current study aimed to investigate the risk factors, endoscopic findings, and treatments of upper gastrointestinal bezoars.

BACKGROUND

Bezoars are compact masses formed by the accumulation of dietary fiber, undigested food, hair, or medications. The majority of bezoars are asymptomatic, but they may cause serious symptoms or even life-threatening events such as bleeding, obstruction, or perforation.

METHODS

This retrospective study was conducted in three gastroenterology clinics between January 2016 and December 2019. Bezoars were detected in 109 of 15,830 endoscopy records (0.68%).

RESULTS

A total of 103 patients (52.4% male) were enrolled in this study. Mean patient age was 60.5±11.3 years. The most frequent risk factors were history of gastric surgery (25.2%), diabetes mellitus (21.3%), hypothyroidism (15.5%), trichophagia (5.8%), and anxiety disorders (2.9%), respectively. The most common endoscopic findings were peptic ulcers (34.9%), erosive gastritis/duodenitis (12.6%), and reflux esophagitis (10.6%). While bezoars were most commonly observed in the stomach (84.4%), the majority of them were phytobezoars (92.2%). The mean number of endoscopic interventions for each patient was 1.5 (range, 1-4). Endoscopy was successful in removing bezoars in 85.4%.

CONCLUSION

The synergistic effect of multiple factors for a long time, such as gastrointestinal surgery, diabetes mellitus or psychiatric disorders, may lead to bezoar formation. These risk factors should be avoided or treated in order to prevent bezoar formation and subsequent life-threatening complications.

Giant gastric bezoar removal from the stomach using combined dual knife-electric snare treatment: a case report

Gastric bezoars are foreign bodies that occur when certain drugs or foods aggregate in the stomach. They cannot be digested and most are unable to pass through the pylorus. Here, we describe a giant hard gastric bezoar that was removed by using combined dual knife–electric snare treatment. This strategy has rarely been reported and can eliminate the need for surgery. The patient exhibited a giant hard gastric bezoar and reported a habit of eating persimmons. A giant persimmon bezoar was treated using a combined dual knife–electric snare approach, without any complications. Follow-up endoscopy revealed that the bezoar had been successfully removed. This report also provides a summary of the diagnostic and therapeutic courses of gastric bezoars.

Upper Gastrointestinal Manifestation of Bezoars and the Etiological Factors: A Literature Review

A gastric bezoar is a compact mass of indigestible foreign materials that accumulate and consolidate in the stomach; however, it can be found in other sites of the gastrointestinal tract. The causative manner of this condition is complex and multifactorial. The main purpose of the review was to raise awareness among clinicians, particularly gastroenterologists, that patients with certain risk factors or comorbid conditions are predisposed to gastric bezoar formation. Early diagnosis and prompt intervention are crucial to avoid bezoar-induced complications. Upper gastrointestinal endoscopy is the standard diagnostic and therapeutic method for gastric bezoars. However, for large size bezoars, surgical intervention is needed.