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Hussein BA, Khammas A, Al-Ozaibi L, Abdallah A, Busharar H, Al-Mazrouei A, Badri F. Phytobezoar impaction in a Meckel's diverticulum; a rare cause of bowel obstruction: Case report and review of literature. Int J Surg Case Rep 2016; 30:165-168. [PMID: 28012337 PMCID: PMC5198632 DOI: 10.1016/j.ijscr.2016.10.070] [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: 08/31/2016] [Accepted: 10/30/2016] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Meckel's diverticulum is the most common anomaly of the gastrointestinal tract, occurring in 1-3% of the general population. The most common complication of Meckel's diverticulum is intestinal obstruction. In this report, we describe a rare cause of intestinal obstruction due to Meckel's; the phytobezoar. After thorough literature review, the authors found about ten individual reports of the same topic. In all these cases, diagnosis was established intra-operatively. CASE PRESENTATION A forty-seven-year old male presented to the emergency department with a one-day history of abdominal pain associated with vomiting and constipation. Physical examination diagnostic tests revealed features of intestinal obstruction. DISCUSSION The lifetime risk of complications in patients with a Meckel'sdiverticulum is usually small and occurs only in up to 4%. In adults' intestinal obstruction is the most common complication (40%). CONCLUSION Complicated Meckel's diverticulum can have different clinical presentations and can cause bowel obstruction. An association with bezoars impaction is possible and it should be suspected in adult patients presenting with bowel obstruction of unknown causes especially those with high vegetarian diet.
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Affiliation(s)
- Bassem Abou Hussein
- General Surgery Department, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates.
| | - Ali Khammas
- General Surgery Department, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Labib Al-Ozaibi
- General Surgery Department, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Alyaa Abdallah
- General Surgery Department, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Hajer Busharar
- General Surgery Department, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Alya Al-Mazrouei
- General Surgery Department, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Faisal Badri
- General Surgery Department, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
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Gupta MK, Kant K, Vishnoi A, Kumar A. "Jodhpur bezoar": giant polyurethane bezoar. Indian J Surg 2015; 77:120-2. [PMID: 25972668 DOI: 10.1007/s12262-014-1192-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 10/28/2014] [Indexed: 11/24/2022] Open
Abstract
Acute upper gastrointestinal obstruction due to foreign body ingestion is rare (<6 % of all small intestinal obstruction). Bezoars tend to grow slowly and only thereafter cause obstruction, if any. Rapid formation of a bezoar within hours of ingestion of the offending substance is a unique entity. Here, we present a case of a 22-year-old Indian male who was brought in the emergency department with history of ingesting chemicals used for refrigerator insulation, with suicidal intent. Within hours, he was operated for suspected perforation. And on the operation table, we came across surprisingly a cast extending from the whole of the esophagus to as far as 2 ft of proximal jejunum! Probably the first of its kind ever known! And no breach in the gut could be found in spite of free gas under the dome of diaphragm, probably due to the chemicals sealing the rent as it solidified!
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Affiliation(s)
- Mukesh Kumar Gupta
- Department of Surgery, Dr. S.N. Medical College, Jodhpur, Rajasthan India ; 649, mahavir nagar 2, kota, Rajasthan 324005 India
| | - Kamal Kant
- Department of Surgery, Dr. S.N. Medical College, Jodhpur, Rajasthan India
| | - Anil Vishnoi
- Department of Surgery, Dr. S.N. Medical College, Jodhpur, Rajasthan India
| | - Abhijit Kumar
- Department of Surgery, Dr. S.N. Medical College, Jodhpur, Rajasthan India
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A non-occlusive bezoar of caecum in a 7-year-old child: ultrasound detection and multimodality imaging management. J Ultrasound 2015; 19:223-6. [PMID: 27635158 DOI: 10.1007/s40477-015-0165-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/06/2015] [Indexed: 10/23/2022] Open
Abstract
Bezoars represent the most frequent foreign bodies of gastro-intestinal system, involving first of all the stomach and small intestine; instead the cecum tract is a very uncommon site for bezoars associated with a poor abdominal symptomatology. We report a case of a very rare localization of bezoar in the caecum tract of the ascending colon in a child affected by undefined abdominal pain. In this case, the abdominal Ultrasound examination showed characteristic imaging findings of bezoar completely comparable to that of Computed Tomography, allowing an early diagnosis of bezoar and the possibility of a conservative treatment for the young patient.
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Abstract
INTRODUCTION Bezoars are uncommon findings in the gastrointestinal tract and are composed of a wide variety of materials. Large metal bezoars are very rare with only a few case reports till date in literature. We report a case of a metal bezoar in a man with Maniac Depressive Psychosis who had a history of ingesting Nails and screws of sizes varying from 2 cm to 15 cm for more than 1 year without causing any perforation and other acute complication. CASE PRESENTATION A 24-year-old man presented with a history of mild dull aching type of abdominal pain of chronic onset and no other GI symptoms. The patient had history of passing small sized nails in the stools and intermittent melena for last 1 year. Physical examination revealed mild tenderness in Para umbilical region. Past medical history was remarkable for treatment of Maniac depressive psychosis. Plain radio graphs revealed objects of metal density contained within a dilated stomach at the level of L2-3 vertebrae in the midline. Celiotomy was performed and 27 metal nails and screws of sizes 6 cm to 15 cm and bent in various shapes were removed from inside the stomach. Post operatively patient recovery was normal and he was referred to psychiatrist. CONCLUSION Abdominal pain in patients with psychiatric disorders can result from rare causes such as bezoars and such bizarre metal nails without causing any acute abdominal symptoms. This report alerts surgeons to rule out bezoars in the differential diagnosis of chronic abdominal pain and melenic stools with no abdominal symptoms in patients with psychiatric health problems.
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Abstract
Bezoars are a mass of ingested foreign materials commonly found in stomach in patients with psychiatric problems or history of gastric surgery. Bezoars are classified based on their composition. Frequently encountered are trichobezoars and phytobezoars composed of hair and fibres of fruits and vegetables, respectively. Primary small-bowel bezoars are a rarity and are essentially encountered in patients having small-bowel diseases such as diverticuli, strictures or tumours. Ileal bezoar leading to intestinal obstruction in absence of parent bezoar in stomach is very rare and so we present a case report here. The diagnosis was made on CT scan in which the cause was found to be an ileal bezoar. Surgical resection of the involved segment was performed and diagnosis confirmed on histopathological examination.
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Affiliation(s)
- Dharita Shah
- Radiology Department, VS General Hospital, Ahmedabad, Gujarat, India.
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Nezih Kök A, Ertekin V, Salman B. Pumpkin Seed Bezoar Initially Suspected as Child Abuse. J Emerg Med 2011; 41:537-8. [DOI: 10.1016/j.jemermed.2009.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Revised: 08/30/2009] [Accepted: 09/02/2009] [Indexed: 11/26/2022]
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Dhinakar M, Balkhair W. Rapunzel Syndrome: A Case Report. Oman Med J 2010; 25:e016. [PMID: 28845219 PMCID: PMC5556320 DOI: 10.5001/omj.2010.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Accepted: 08/28/2010] [Indexed: 11/03/2022] Open
Abstract
Rapunzel syndrome is a rare type of trichobezoar with extension of the hair into the small bowel. Clinical presentation can be deceptive ranging from upper abdominal mass to gastrointestinal obstructive symptoms. In majority of cases, the diagnosis is made very late in the history of the disease due to late patient presentation in lieu of his underlying mental disorder. Surgical removal is necessary. One such case is describe here stressing the importance of imaging in the diagnosis of this condition.
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Affiliation(s)
- Manjula Dhinakar
- Department of Radiology, Sultan Qaboos Hospital, Salalah, Sultanate of Oman
| | - Warda Balkhair
- Department of Surgery, Sultan Qaboos Hospital, Salalah, Sultanate of Oman
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Prieto-Aldape MR, Almaguer-García FI, Figueroa-Jiménez SE, Fernández-Díaz O, Mora-Huerta JA, González-Ojeda A. Relapsing massive metal bezoar: a case report. J Med Case Rep 2009; 3:56. [PMID: 19208216 PMCID: PMC2649143 DOI: 10.1186/1752-1947-3-56] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Accepted: 02/10/2009] [Indexed: 11/12/2022] Open
Abstract
Introduction Bezoars are uncommon findings in the gastrointestinal tract and are composed of a wide variety of materials. We report a case of a relapsing metal bezoar in a man with schizophrenia. Case presentation A 34-year-old man presented with a history of sub-acute onset of mild diffuse abdominal pain and abdominal distention. Physical examination revealed dullness to percussion in the upper and lower left quadrants. Past medical history was remarkable for epilepsy, schizophrenia and previous abdominal surgery for intestinal occlusion. Plain radiographs revealed objects of metal density contained within a dilated stomach. Celiotomy was performed revealing more than 350 metal objects inside the stomach. The patient was discharged and referred to a psychiatric facility. Conclusion Intestinal occlusion in patients with psychiatric disorders can result from rare causes such as bezoars. This report alerts surgeons to rule out bezoars in the differential diagnosis of intestinal occlusion in people with mental health problems.
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Affiliation(s)
- Manuel Rodrigo Prieto-Aldape
- Surgical Division, Medical Research Unit, Clinical Epidemiology, Western National Medical Center, Mexican Institute of Social Security, Belisario Domínguez 1000, Guadalajara, Jalisco, Mexico.
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Agrawal V, Joshi MK, Jain BK, Gupta A. Plasticobezoar-another new entity for Rapunzel syndrome. Indian J Pediatr 2009; 76:229-30. [PMID: 19129987 DOI: 10.1007/s12098-008-0236-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Accepted: 01/15/2008] [Indexed: 12/19/2022]
Abstract
Rapunzel syndrome- a form of trichobezoar occurs when a gastric trichobezoar extends beyond the pylorus into the bowel. We report two cases of Rapunzel syndrome, one of them caused by ingestion of plastic material, so as to name it as a 'Plasticobezoar'. To the best of our knowledge no Rapunzel syndrome due to this material has been reported so far.
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Affiliation(s)
- Vivek Agrawal
- Department of Surgery University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India.
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Unusual acute formed gastric bezoars due to plaster ingestion successfully treated by gastric irrigation: report of two cases. Emerg Radiol 2007; 15:357-9. [PMID: 18046589 DOI: 10.1007/s10140-007-0684-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Accepted: 10/29/2007] [Indexed: 10/22/2022]
Abstract
Bezoars usually present as a mass in the stomach. One of the uncommon causes of bezoars is ingestion of plaster in a suicidal attempt. We present here two patients with acute formed gastric bezoars due to plaster ingestion. Their main complaints were abdominal pain, nausea, and vomiting. Clinical examination revealed a slightly distended abdomen and a palpable mass in the epigastric region. Plain abdominal radiograph showed plaster casts in the stomach. They were successfully treated by insertion of a nasogastric tube and gastric irrigation using saline solution over 24 h. Post-treatment abdominal X-ray showed dissolved plaster passing through the small intestines and the colon. The treatment course was uneventful, and finally patients were discharged with good condition and referred to a psychiatric clinic for treatment of underlying psychological disorder.
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Abstract
Trichotillomania is an intriguing psychosomatic entity in which there is an irresistible desire to pull out the hair from the scalp, eyelashes, eyebrows and other parts of the body. The process results in an instant release of tension, a sense of relief and security. However, non-scaring alopecia is its clinical presentation. The development of trichobezoar following ingestion of the pulled hair is its salient complication in a few cases. Subsequently, it may cause symptoms pertaining to the gastrointestinal tract culminating in intestinal obstruction, perforation, pancreatitis and obstructive jaundice. The Rapunzel syndrome (trichobezoar) may occur when gastrointestinal obstruction is produced by a rare manifestation of a trichobezoar with a long tail that extends to or beyond the ileocecal valve. In most cases in children, trichotillomania +/- trichobezoar is a habit disorder and thus has a better prognosis. However, in adults the psychopathology is usually deeper and thus entails a poor prognosis. The diagnosis is made after taking a thorough history, noting the clinical features and evaluating a hair-root examination, where telogen hair is (almost) completely lacking, which distinguish trichotillomania from other hair disorders. Treatment modalities vary in childhood and adult varieties. Apart from psychotherapy, the drug treatment involves several agents including selective serotonin reuptake inhibitors (SSRIs) and domipramine. Trichobezoar/Rapunzel syndrome requires surgical intervention.
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Affiliation(s)
- V N Sehgal
- Dermato-Venereology (Skin/VD) Centre, Sehgal Nursing Home, Panchwati, Azadpur, Delhi and Skin Institute and School of Dermatology, Greater Kailash, New Delhi, India.
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Yegane RA, Bashashati M, Bashtar R, Ahmadi M. Gastrointestinal obstruction due to plaster ingestion: a case-report. BMC Surg 2006; 6:4. [PMID: 16483375 PMCID: PMC1386707 DOI: 10.1186/1471-2482-6-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Accepted: 02/16/2006] [Indexed: 11/10/2022] Open
Abstract
Background Plaster ingestion forming gastric bezoar is a strange way to attempt suicide and this method has not yet been reported. It may lead to a mechanical obstruction of the gut, especially the pyloric region, and could manifest with abdominal pain, epigastric distress, nausea, vomiting, and fullness. Case presentation Herein we report a case of a 37 year-old woman presenting with plaster ingestion and gastric outlet obstruction, who underwent surgery. At six months follow-up the patient was fully recovered. Conclusion Plaster has no toxic or erosive effects. Endoscopic or surgical removing of such material is recommended. Moreover, psychiatric intervention and management is imperative to prevent recurrence in such cases.
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Affiliation(s)
- Rooh- Allah Yegane
- Department of Surgery, Loqman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Kamali St, Tehran, Iran
| | - Mohammad Bashashati
- Researcher of Gastroenterology and Surgery, Loqman-Hakim Hospital, Shahid Beheshti University of Medical Sciences Kamali St, Tehran, Iran
| | - Reza Bashtar
- General practitioner, Loqman-Hakim Hospital, Shahid Beheshti University of Medical Sciences Kamali St, Tehran, Iran
| | - Mina Ahmadi
- General practitioner, Loqman-Hakim Hospital, Shahid Beheshti University of Medical Sciences Kamali St, Tehran, Iran
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Durkhure R, JP S, Singhal V. Cotton Bezoar--a rare cause of intestinal obstruction: case report. BMC Surg 2003; 3:5. [PMID: 12956890 PMCID: PMC194753 DOI: 10.1186/1471-2482-3-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2003] [Accepted: 09/04/2003] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Bezoars usually present as a mass in the stomach. The patient often has a preceding history of some psychiatric predisposition. Presentation could be in the form of trichophagy followed by trichobezoar (swallowing of hair leading to formation of bezoar), orphytobezoar (swallowing of vegetable fibres). Rapunzel syndrome is a condition where the parent bezoar is in the stomach and a tail of the fibres or hair extends in to the jejunum. Presentation as intestinal obstruction due to a bezoar in the intestine without a parent bezoar in the stomach is rare, therefore we report it here. CASE REPORT A 35 year old lady tailor with a previous history of receiving treatment for depression on account of being infertile- years after her marriage, presented to the surgical emergency department with features of acute intestinal obstruction. Exploratory laparotomy and enterotomy revealed a cotton bezoar in the terminal ileum without a parent bezoar in the stomach. She was managed by resection of the affected segment of the ileum and end-to-end anastomosis of the bowel. In the postoperative period the patient gave a history of ingesting cotton threads whenever she was depressed. CONCLUSION Presence of cotton bezoar is rare and an intestinal bezoar in the absence of parent bezoar in the stomach is still rarer.
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Affiliation(s)
- Rakesh Durkhure
- Department of surgery vardhman mahavir medical college safdar jang hospital, New Delhi-India
| | - Singh JP
- Department of surgery vardhman mahavir medical college safdar jang hospital, New Delhi-India
| | - Vinay Singhal
- Department of surgery vardhman mahavir medical college safdar jang hospital, New Delhi-India
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