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Zheng X, Qiu B, Jin XW, Liu LN, Wang P, Yu HJ, Zhang J, Geng WJ, Wang R, Liu H. Endoscopic lithotripsy combined with drug lithotripsy vs. drug lithotripsy for the treatment of phytobezoars: analysis of 165 cases. Surg Endosc 2024; 38:2788-2794. [PMID: 38587640 DOI: 10.1007/s00464-024-10741-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/28/2024] [Indexed: 04/09/2024]
Abstract
AIM To analyze efficacy of endoscopic lithotripsy combined with drug lithotripsy as compared with drug lithotripsy for the treatment of phytobezoars. METHODS We collected and evaluated case records of 165 patients with phytobezoars from 2014 to 2023. And we analyzed demographic and clinical characteristics, imaging features, endoscopic features, complications of phytobezoars, and compared efficacy between endoscopic lithotripsy combined with drug lithotripsy (Group A) and drug lithotripsy (sodium bicarbonate combined with proton pump inhibitor) (Group B). RESULTS The median age of patients with phytobezoars was 67.84 ± 4.286 years old. Abdominal pain was the most common symptom and peptic ulcers (67.5%) were the most common complication. Bezoar-induced ulcers were more frequent in the gastric angle. The success rate of phytobezoars vanishing in Group A and Group B were similar (92.3% vs. 85.1% within 48 h, 98.7% vs. 97.7% within a week), while the average hospitalization period, average hospitalization cost, second endoscopy rate, and average endoscopic operation time were significantly lower in patients in Group B than in Group A. CONCLUSION Drug lithotripsy is the preferred effective and safe treatment option for phytobezoars. We advise that an endoscopy should be completed after 48 h for drug lithotripsy.
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Affiliation(s)
- Xiao Zheng
- Department of Gastroenterology, Peking University Shougang Hospital, Jinyuanzhuang 9 Road, Shijingshan District, Beijing, 100041, China
| | - Bin Qiu
- Department of Oncology, Peking University Third Hospital, Beijing, 100191, China
| | - Xiao-Wei Jin
- Department of Gastroenterology, Peking University Shougang Hospital, Jinyuanzhuang 9 Road, Shijingshan District, Beijing, 100041, China.
| | - Lin-Na Liu
- Department of Gastroenterology, Peking University Shougang Hospital, Jinyuanzhuang 9 Road, Shijingshan District, Beijing, 100041, China
| | - Peng Wang
- Department of Gastroenterology, Peking University Shougang Hospital, Jinyuanzhuang 9 Road, Shijingshan District, Beijing, 100041, China
| | - Hai-Jing Yu
- Department of Gastroenterology, Peking University Shougang Hospital, Jinyuanzhuang 9 Road, Shijingshan District, Beijing, 100041, China
| | - Juan Zhang
- Department of Gastroenterology, Peking University Shougang Hospital, Jinyuanzhuang 9 Road, Shijingshan District, Beijing, 100041, China
| | - Wen-Jing Geng
- Department of Gastroenterology, Peking University Shougang Hospital, Jinyuanzhuang 9 Road, Shijingshan District, Beijing, 100041, China
| | - Rui Wang
- Department of Gastroenterology, Peking University Shougang Hospital, Jinyuanzhuang 9 Road, Shijingshan District, Beijing, 100041, China
| | - Hua Liu
- Department of Gastroenterology, Peking University Shougang Hospital, Jinyuanzhuang 9 Road, Shijingshan District, Beijing, 100041, China
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Lee DJW, Fong KL, Tee YC, Aldridge OB. All Tangled Up: Meter-Long Gastric Trichobezoar Causing Multiple Intussuscepting Points in an Adult. Cureus 2023; 15:e36651. [PMID: 37102008 PMCID: PMC10123237 DOI: 10.7759/cureus.36651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 04/28/2023] Open
Abstract
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.
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Caleça Emidio F, Pereira RC, Blanco Saez R, Abegão T, Ribeiro AS. Rectal Bezoar: A Rare Cause of Intestinal Obstruction. Cureus 2023; 15:e35726. [PMID: 36875249 PMCID: PMC9983705 DOI: 10.7759/cureus.35726] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 03/06/2023] Open
Abstract
Bezoars are conglomerates of undigested contents that accumulate in the gastrointestinal tract. They can have different compositions, such as fibers, seeds, vegetables (phytobezoars), hair (trichobezoars), and medication (pharmacobezoars). Bezoars are typically caused by an impaired grinding mechanism of the stomach or interdigestive migrating motor complex, but the composition of ingested material can also play a role in their formation. Gastric dysmotility, previous gastric surgery, and gastroparesis are some of the risk factors that can increase the likelihood of developing bezoars. While bezoars are usually asymptomatic and found in the stomach, they can sometimes migrate to the small intestine or colon and cause complications such as intestinal obstruction or perforation. Endoscopy is essential for diagnosis and etiology, and treatment depends on the composition, which can include chemical dissolution or surgical intervention. We present a case of an 86-year-old woman, who had a bezoar located in an unusual location (rectum), most likely due to migration. This condition led to symptoms of intermittent intestinal obstruction and rectal bleeding. However, due to anal stenosis, the patient was unable to expel the bezoar. Its removal was not possible through various endoscopic techniques. Therefore, it was removed via fragmentation, using an anoscope and forceps, due to its hard/stone-like consistency. This case highlights the importance of considering bezoars in the differential diagnosis of gastrointestinal bleeding and illustrates the importance of prompt diagnosis and appropriate techniques for the removal of bezoars.
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Affiliation(s)
- Fábio Caleça Emidio
- Department of Internal Medicine, Centro Hospitalar Universitário do Algarve, Hospital de Faro, Faro, PRT
| | - Rafaela C Pereira
- Department of Internal Medicine, Centro Hospitalar Universitário do Algarve, Hospital de Faro, Faro, PRT
| | - Rosário Blanco Saez
- Department of Internal Medicine, Centro Hospitalar Universitário do Algarve, Hospital de Faro, Faro, PRT
| | - Teresa Abegão
- Department of Internal Medicine, Centro Hospitalar Universitário do Algarve, Hospital de Faro, Faro, PRT
| | - Ana S Ribeiro
- Department of Internal Medicine, Centro Hospitalar Universitário do Algarve, Hospital de Faro, Faro, PRT
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Kyin C, Patel P, Casas-Melley A, Abdalla WM, Westmoreland T. Acute Case of Trichobezoar Diagnosed From Computed Tomography and 3D Images: Rapunzel Syndrome Re-examined. Cureus 2023; 15:e35597. [PMID: 37007333 PMCID: PMC10063164 DOI: 10.7759/cureus.35597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2023] [Indexed: 03/05/2023] Open
Abstract
A trichobezoar is a rare cause of abdominal pain due to an indigestible mass in the gastrointestinal tract that is composed of a patient's hair. If a trichobezoar grows and extends from the gastric body to the pylorus and into the small bowel, it is considered Rapunzel syndrome. We present a case of an 11-year-old female patient with Rapunzel syndrome who presented with four weeks of colicky abdominal pain, vomiting, constipation, and severe malnutrition. Computed tomography of the abdomen and pelvis with 3D rendering demonstrated a large bezoar, and the patient was successfully treated with exploratory laparotomy, gastrostomy, and removal of the trichobezoar intact.
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5
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Mesfin T, Tekalegn Y, Aman M, Geta G, Ketema A, Defere F, Girma D, Tsegaye M, Mengistu T, Seyoum K. Ingestion of Metallic Materials Found in the Stomach and First Part of the Duodenum of a Schizophrenic Man: Case Report. Int Med Case Rep J 2022; 15:681-684. [DOI: 10.2147/imcrj.s386883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022] Open
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6
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Hagopian GG, Johnson KP, Shahsavari D, Parkman HP. Meal Eating Characteristics of Patients with Gastroparesis. Dig Dis Sci 2022; 67:3872-3880. [PMID: 34324088 DOI: 10.1007/s10620-021-07190-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/21/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patients with gastroparesis often consume only small meals due to early satiety. AIMS (1) Describe meal eating characteristics of patients with gastroparesis; (2) Relate meal eating characteristics to symptoms, gastric emptying (GE), and body weight. METHODS Patients with gastroparesis filled out questionnaires including Patient Assessment of Upper GI Symptoms (PAGI-SYM), and questionnaire about meal habits and body weight. Patients underwent gastric emptying scintigraphy. RESULTS Of 192 gastroparesis patients, 93% endorsed early satiety (ES) with severity of 3.7 ± 1.5 (scored from 0-5) and 93% endorsed postprandial fullness (PPF) with severity of 3.9 ± 1.3. Time spent consuming meals averaged 13.6 ± 17.7 min. Main reasons patients stopped eating were fullness (61%), nausea (48%), and abdominal pain (31%). Time spent eating correlated inversely with severity of nausea (r = -0.18, p < 0.05), stomach fullness (r = -0.21, p < 0.01), PPF (r = -0.23, p < 0.01), loss of appetite (r = -0.34, p < 0.01). Postprandial fullness lasted for 316 ± 344 min. Duration of PPF correlated with nausea (r = 0.30, p < 0.01), retching (r = 0.29, p < 0.01), vomiting (r = 0.28, p < 0.01), stomach fullness (r = 0.33, p < 0.01), loss of appetite (r = 0.35, p < 0.01), and constipation (r = 0.27, p < 0.01). Underweight patients had increased inability to finish a normal size meal (p < 0.01), loss of appetite (p < 0.01), and lower abdominal pain/discomfort (p < 0.05). Patients had lost 3.06 ± 10.60 kgs from their baseline weight. Weight loss correlated with nausea (r = 0.26, p < 0.01), ES (r = 0.30, p < 0.01), loss of appetite (r = 0.28, p < 0.01). CONCLUSIONS Early satiety and postprandial fullness were common with high severity. The main reasons for meal cessation were early satiety, nausea, and abdominal pain. Body weight and change in body weight were associated with symptoms of gastroparesis.
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Affiliation(s)
- Garo G Hagopian
- Section of Gastroenterology, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA
| | - Kathleen P Johnson
- Section of Gastroenterology, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA
| | - Dariush Shahsavari
- Section of Gastroenterology, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA
| | - Henry P Parkman
- Section of Gastroenterology, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA.
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Edwards M, Kaz A, Wander PL. Trichobezoar Without Trichotillomania-a Case Report. J Gen Intern Med 2022; 37:962-965. [PMID: 34981351 PMCID: PMC8904306 DOI: 10.1007/s11606-021-07194-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 10/01/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Mitchell Edwards
- Veterans Affairs Puget Sound Health Care System, Hospital and Specialty Medicine, Seattle, WA, USA.
- Department of Medicine, University of Washington, Seattle, WA, USA.
| | - Andrew Kaz
- Veterans Affairs Puget Sound Health Care System, Hospital and Specialty Medicine, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Pandora L Wander
- Veterans Affairs Puget Sound Health Care System, Hospital and Specialty Medicine, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
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8
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Chaudhry M, Iqbal N, Malik A. Acute Cholecystitis Masking a Gastric Bezoar. Cureus 2022; 14:e22673. [PMID: 35386171 PMCID: PMC8967111 DOI: 10.7759/cureus.22673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 01/10/2023] Open
Abstract
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.
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9
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Alemam A, Shin D, Balar B. Gastric Bezoar: Cause of Weight Loss in a Patient With Previous Bariatric Surgery. Cureus 2021; 13:e20139. [PMID: 35003973 PMCID: PMC8723780 DOI: 10.7759/cureus.20139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 11/17/2022] Open
Abstract
Gastric bezoar is a concretion of undigested material found in the stomach and is classified by its composition. Patients may remain asymptomatic or present with a variety of gastrointestinal symptoms. Upper gastrointestinal endoscopy is required to establish the diagnosis. Treatment options include chemical dissolution, endoscopic removal, or surgical removal. Here, we present a rare case of gastric bezoar in a patient with a remote history of bariatric surgery presenting with acute weight loss.
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10
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Delimpaltadaki DG, Gkionis IG, Flamourakis ME, Strehle AF, Bachlitzanakis EN, Giakoumakis MI, Christodoulakis MS, Spiridakis KG. A rare giant gastric trichobezoar in a young female patient: Case report and review of the literature. Clin Case Rep 2021; 9:e05152. [PMID: 34938545 PMCID: PMC8665721 DOI: 10.1002/ccr3.5152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/07/2021] [Accepted: 11/19/2021] [Indexed: 12/13/2022] Open
Abstract
A bezoar is an aggregate of undigested foreign materials that accumulate in the gastrointestinal tract and may cause serious symptoms or even life-threatening complications. Trichobezoars, a subtype of bezoars, are a rare condition usually occurring in females with psychiatric disorders, with Rapunzel syndrome being an uncommon form of trichobezoar.
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11
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Climaco K, Roubik D, Gorrell R. The differential for chest pain: when the most common cause is not the answer-a case of de novo esophageal bezoar. Surg Case Rep 2021; 7:245. [PMID: 34800192 PMCID: PMC8605939 DOI: 10.1186/s40792-021-01311-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/13/2021] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Kevin Climaco
- General Surgery Department, William Beaumont Army Medical Center, El Paso, TX, USA.
| | - Daniel Roubik
- General Surgery Department, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Robert Gorrell
- General Surgery Department, William Beaumont Army Medical Center, El Paso, TX, USA
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12
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Balawender K, Pliszka A, Możdżeń K, Kłos M, Ogorzałek A, Grabarek BO. WITHDRAWN: Bezoars – Nonspecific symptoms, difficult diagnosis, simple treatment. Int J Surg Case Rep 2021. [DOI: 10.1016/j.ijscr.2021.106379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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13
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Trichobezoar in two different localization:a case report. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.689611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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14
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Alsahwan AG, Almarhoon AM, AlSafwani J, Alsahwan H, Alturki N. Intestinal Obstruction Secondary to Multiple Gastrointestinal phytobezoars, A Rare presentation. Int J Surg Case Rep 2021; 83:106004. [PMID: 34052714 PMCID: PMC8176354 DOI: 10.1016/j.ijscr.2021.106004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Intestinal obstruction considered to be one of the most common surgical presentation. Adhesions secondary to previous operations, hernias, neoplasms, inflammatory bowel disease, intussusception, or volvulus are the usual causes of intestinal obstruction but bezoar can presents in 0.4-4%. Bezoar can be trapped in different locations throughout the gastrointestinal tract and it can be solitary or multiple lesions. Case presentation This is a 37-year-old male, known case of diabetes mellitus, Presented to the Emergency Department complaining of generalized abdominal pain for 2 days duration. Associated with abdominal distention, fever, nausea, vomiting and obstipation. There was a history of persimmon intake. Unremarkable past surgical history. On examination, He was tachycardic, other vital signs were within normal. Abdominal examination showed abdominal distention and Sluggish bowel sound. Abdominal X-ray revealed multiple air-fluid levels. An abdominal CT scan with IV contrast revealed an intra-luminal mass in the ileum and intra-gastric mass with suspicious of bezoars. He underwent exploratory laparotomy, gastrostomy to remove intra-gastric bezoar, and enterotomy to remove the ileal bezoar. Clinical discussion Intestinal obstruction is considered to be the most common complication of this entity; other possible complications include gastric ulcer, gastritis, and gastric perforation. Due to limitations of endoscopy and barium enema in the diagnosis of bezoar, Abdominal CT-scan is considered to be the gold standard in the diagnosis. The management of phytobezoar can be either conservative or surgical, depends on the lesion size and location. Conclusion Although intestinal obstruction secondary to bezoar is rare, multiple levels of gastrointestinal obstruction should raise the suspicion of bezoar. Bezoar can be trapped in different locations throughout the gastrointestinal tract and it can be solitary or multiple lesions. The predisposing risk factors for bezoar formation include previous gastric surgery, gastroparesis, peptic ulcer disease, or psychiatric illness. Abdominal CT-scan considered the gold standard in the diagnosis for bezoar. The management of phytobezoar can either be conservative or surgical depends on the lesion size and location.
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Affiliation(s)
| | - Ameen M Almarhoon
- Department of General Surgery, Qatif Central Hospital, Qatif, Saudi Arabia
| | - Jihad AlSafwani
- Department of General Surgery, Qatif Central Hospital, Qatif, Saudi Arabia
| | - Hanan Alsahwan
- Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Neamat Alturki
- Department of General Surgery, Qatif Central Hospital, Qatif, Saudi Arabia
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Hemmasi G, Zanganeh E, Hosseini SA, Alimadadi M, Ahmadi A, Hajiebrahimi S, Seyyedmajidi M. Risk factors, endoscopic findings, and treatments in upper gastrointestinal bezoars: multi-center experience in Iran. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2021; 14:160-164. [PMID: 33968343 PMCID: PMC8101514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
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.
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Affiliation(s)
| | - Elahe Zanganeh
- Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences, Gorgan, Iran
| | | | - Mehdi Alimadadi
- Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences, Gorgan, Iran
| | - Anahita Ahmadi
- Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences, Gorgan, Iran
| | - Shahin Hajiebrahimi
- Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences, Gorgan, Iran
| | - Mohammadreza Seyyedmajidi
- Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences, Gorgan, Iran
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16
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Pan G, Kim RD, Campsen J, Rofaiel G. Small bowel obstruction caused by a bezoar following an adult simultaneous liver-kidney transplantation: A case report. World J Clin Cases 2020; 8:4109-4113. [PMID: 33024768 PMCID: PMC7520779 DOI: 10.12998/wjcc.v8.i18.4109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/10/2020] [Accepted: 08/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Small bowel obstructions (SBOs) are common following a large intra-abdominal operation; however, SBOs caused by bezoars are unreported in patients following liver-kidney transplantation procedures, particularly in adults.
CASE SUMMARY A 65-year-old Caucasian female presented with nausea and nonbilious emesis during her postoperative course following a simultaneous liver-kidney transplantation. She developed worsening nausea and vomiting with significant abdominal distension and obstipation. Computed tomography imaging showed a marked abnormal dilation of multiple small bowel loops with a distinct transition point that was suggestive of a small bowel obstruction. An exploratory laparotomy revealed a foreign body in the intestinal track approximately 30 cm from the ileocecal valve. The foreign body was extracted and identified as a bezoar with hair follicles and old digestive contents. Following the operation, the patient demonstrated rapid clinical improvement with resolution of nausea, emesis, and progress in bowel motility.
CONCLUSION SBOs caused by bezoars can occur immediately following a liver-kidney transplantation and should not be discounted as a diagnosis.
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Affiliation(s)
- Gilbert Pan
- Department of Surgery, Division of Transplantation and Advanced Hepatobiliary Surgery, University of Utah School of Medicine, Salt Lake, UT 84132, United States
| | - Robin D Kim
- Department of Surgery, Division of Transplantation and Advanced Hepatobiliary Surgery, University of Utah School of Medicine, Salt Lake, UT 84132, United States
| | - Jeffrey Campsen
- Department of Surgery, Division of Transplantation and Advanced Hepatobiliary Surgery, University of Utah School of Medicine, Salt Lake, UT 84132, United States
| | - George Rofaiel
- Department of Surgery, Division of Transplantation and Advanced Hepatobiliary Surgery, University of Utah School of Medicine, Salt Lake, UT 84132, United States
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17
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Huang Z, Cheng F, Wei W. Giant gastric bezoar removal from the stomach using combined dual knife-electric snare treatment: a case report. J Int Med Res 2020; 48:300060520946523. [PMID: 32865106 PMCID: PMC7469736 DOI: 10.1177/0300060520946523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
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.
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Affiliation(s)
- Zhong Huang
- Department of Gastroenterology, Zigong First People's Hospital, Zigong, China
| | - Fang Cheng
- Department of Gastroenterology, Zigong First People's Hospital, Zigong, China
| | - Wei Wei
- Department of Gastroenterology, Zigong First People's Hospital, Zigong, China
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