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Wang F, Hu C, Zhu Z, Wu D, Shu M. Clinical Characteristics of Children With Foreign Bodies in the Digestive Tract and Analysis of Risk Factors for Serious Complications. Clin Pediatr (Phila) 2024:99228241253344. [PMID: 38756001 DOI: 10.1177/00099228241253344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Foreign bodies (FBs) in the digestive tract are common in children, we analyzed the clinical characteristics of children with FBs in the digestive tract and discuss the risk factors for serious complications. We retrospectively reviewed clinical data of 139 children with FBs in the digestive tract. Based on the severity of complications caused by FBs, the patients were divided into risk and general groups for analysis and comparison. Significant differences were observed in the retention sites of FBs, the diameter of FBs retained in the esophagus, FBs retention time exceeding 24 h, and the absence of witnesses between the 2 groups. Inadequate care, button batteries (BBs), ingested mmFBs, FBs retained in the esophagus, long-term retention, and giant gastric bezoars may cause serious complications. In addition to treating FBs and the complications, clinicians should emphasize the importance of childcare to prevent the ingestion of FBs.
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Affiliation(s)
- Fengge Wang
- Department of Gastroenterology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Chijun Hu
- Department of Gastroenterology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Zhenni Zhu
- Department of Gastroenterology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Daiqin Wu
- Department of Gastroenterology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Meng Shu
- Department of Gastroenterology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
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2
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Delgado Galan M, Rabago LR. Has Coca-Cola treatment become the first-line therapy for gastric bezoars, both in general and specifically for western countries? World J Gastrointest Endosc 2024; 16:237-243. [PMID: 38813574 PMCID: PMC11130549 DOI: 10.4253/wjge.v16.i5.237] [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: 03/19/2024] [Revised: 04/10/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024] Open
Abstract
Phytobezoars is a rare disease and less common in Western countries. The stomach is the primary site for these formations, and endoscopic treatment involving fragmentation and extraction has traditionally been the most effective approach. However, medical treatments using enzymatic and chemical agents, such as cellulase and Coca-Cola, aimed at dissolving the bezoars, have also been utilized, showing varying degrees of resolution success. Notably, the oral dissolution treatment with Coca-Cola has emerged as a promising, simpler, and more cost-effective method. The study by Liu et al represents an important step in clinical research on this topic, despite some limitations that need addressing for a more comprehensive understanding of its findings. Key considerations for future research include sample size calculation, endoscopic procedure details, outpatient vs. inpatient treatment, and detailed cost calculations. The study's exclusions, such as patients with upper gastric surgery, phytobezoars older than 14 d, and cases of gastroparesis, limit its applicability to broader populations, especially in Western countries. Given the promising outcomes of the Coca-Cola treatment, it's advocated as a first-line therapy for phytobezoars. Nonetheless, further research is essential to overcome these limitations. However special situations such as perforation or small bowel obstruction will require surgical treatment.
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Affiliation(s)
| | - Luis Ramon Rabago
- Department of Gastroenterology, Hospital San Rafael, Madrid 28016, Spain
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Matsuura K, Oura S, Ishibashi K, Matsumoto Y, Ono W. Successful endoscopic treatment of a huge trichobezoar in a 10-year-old girl. DEN OPEN 2024; 4:e357. [PMID: 38562181 PMCID: PMC10982458 DOI: 10.1002/deo2.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/26/2024] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
A 10-year-old girl was admitted to our hospital due to acute pancreatitis. Computed tomography showed an intra-gastric mass containing multiple small air bubbles. Ultrasound showed a well-circumscribed large oval mass with a broad acoustic shadow. Endoscopy revealed a huge trichobezoar with many movable hairs, being judged by the cause of acute pancreatitis. Due to the parents' strong preference not to leave any surgical scars on their daughter, the patient underwent endoscopic treatment. The trichobezoar grasped with a snare was too large to pass through the esophageal-gastric junction. In addition, the outer layer of the trichobezoar was too hard to be cut with conventional endoscopic devices but was successfully cut with a FlushKnife. The content of the trichobezoar was much softer than its hard surface but needed appropriate counter-traction to be torn off the tissue. Two alligator forceps via a dual-channel multi-bending scope were able to give sufficient counter-traction to the inner tissue of the trichobezoar, successfully removing the trichobezoar through piece-by-piece tearing off. All the endoscopic procedures took seven hours for the complete trichobezoar removal. The total weight of the dissected mass was 180 g. The girl resumed eating on the next day and was discharged on the third day. Physicians should note that a medical team with full endoscopic expertise can remove huge trichobezoars using a FlushKnife, a dual-channel multi-bending scope, and two alligator forcepses.
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Affiliation(s)
- Ko Matsuura
- Department of GastroenterologyKishiwada Tokushukai HospitalOsakaJapan
| | - Shoji Oura
- Department of SurgeryKishiwada Tokushukai HospitalOsakaJapan
| | - Kohei Ishibashi
- Department of GastroenterologyKishiwada Tokushukai HospitalOsakaJapan
| | | | - Wataru Ono
- Department of GastroenterologyKishiwada Tokushukai HospitalOsakaJapan
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Sugimori H, Masaki S, Honjo H, Kudo M, Watanabe T. Visualization of Gastrointestinal Bezoar Movement Causing and Releasing Small Bowel Obstruction on Computed Tomography in a Patient With Diabetes Mellitus. Cureus 2023; 15:e49133. [PMID: 38130514 PMCID: PMC10733117 DOI: 10.7759/cureus.49133] [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: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Although delayed gastric emptying promotes gastrointestinal bezoar formation in patients with diabetes mellitus (DM), the association between movement of gastrointestinal bezoars and glycemic status remains unclear. We report a case of small bowel obstruction (SBO) caused by impaction of the migrated gastric bezoar into the small bowel in a patient with DM. Correction of hyperglycemia and lactic acidosis led to normalization of gastrointestinal motility, followed by expulsion of the impacted bezoar and resolution of SBO. This case suggests a link between hyperglycemia, metabolic acidosis, and gastrointestinal motility based on visualization of gastrointestinal bezoar movement in the gastrointestinal tract using computed tomography.
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Affiliation(s)
- Hironobu Sugimori
- Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, JPN
| | - Sho Masaki
- Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, JPN
| | - Hajime Honjo
- Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, JPN
| | - Masatoshi Kudo
- Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, JPN
| | - Tomohiro Watanabe
- Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, JPN
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Di Buono G, Russo G, Amato G, Micheli M, Geraci G, Agrusa A. A rare presentation of gastric phytobezoar: Simultaneous bleeding and perforation. combined laparoscopic and endoscopic approach. Report of a case. Int J Surg Case Rep 2023; 112:108841. [PMID: 37832358 PMCID: PMC10667765 DOI: 10.1016/j.ijscr.2023.108841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION Bezoars are intraluminal conglomerates of indigestible foreign materials that accumulate in the gastrointestinal tract. We describe our experience with a patient with gastric perforation and concomitant gastric haemorrhage with severe anaemia, in whom we successfully extracted a giant gastric phytobezoar by cooperative laparoscopic and endoscopic surgery. CASE PRESENTATION A 68-year-old man was admitted with melena and septic shock. CT scan revealed a gastric perforation. We performed a combined laparoscopic and endoscopic approach with gastrotomy, removal of the phytobezoar and laparoscopic gastric suture. The suture was examined for leakage with the endoscopic hydropneumatic test to obtain direct vision of the suture and no evidence of leakage by insufflation of the area. DISCUSSION Gastric bezoars can be managed conservatively, endoscopically or surgically. Endoscopic removal, if effective, would be an attractive alternative for bezoar treatment. Usually endoscopic attempts are unsuccessful because of the large size of the bezoar and the difficulty in fragmentation. The laparoscopic approach for bezoar seems to have better postoperative outcomes. The main criticisms of the technique are abdominal spillage with risk of contamination as well as longer operative times. CONCLUSION In our case we simultaneously performed laparoscopic surgery and endoscopic operative procedure in accordance with the principles of laparoscopic and endoscopic cooperative surgery to treat the gastric bezoar in order to overcome the limits of a single technique.
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Affiliation(s)
- Giuseppe Di Buono
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
| | - Gaia Russo
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giuseppe Amato
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Matilde Micheli
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Girolamo Geraci
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
| | - Antonino Agrusa
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
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Kang WR, Park SY, You HS, Kim DH, Park CH, Choi SK, Kim HS. A Single-center 12-year Experience of Patients with Gastrointestinal Bezoars. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2023; 81:253-258. [PMID: 37350520 DOI: 10.4166/kjg.2023.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/06/2023] [Accepted: 04/06/2023] [Indexed: 06/24/2023]
Abstract
Background/Aims Gastrointestinal (GI) bezoars are relatively rare diseases with clinical characteristics and treatment modalities that depend on the location of the bezoars. This study evaluated the clinical characteristics and treatment outcomes in patients with GI bezoars. Methods Seventy-five patients diagnosed with GI bezoars were enrolled in this study. Data were collected on the demographic and clinical characteristics and the characteristics of the bezoars, such as type, size, location, treatment modality, and clinical outcomes. Results Among the 75 patients (mean age 71.2 years, 38 males), 32 (42.6%) had a history of intra-abdominal surgery. Hypertension (43%) and diabetes (30%) were common morbidities. The common location of the bezoars was the stomach in 33 (44%) and the small intestine in 33 (44%). Non-surgical management, including adequate hydration, chemical dissolution, and endoscopic removal, was successful in 2/2 patients with esophageal bezoars, 26/33 patients with gastric bezoars, 7/9 patients with duodenal bezoars, and 20/33 patients with small intestinal bezoars. The remaining patients had undergone surgical management. Conclusions The management of GI bezoars requires multidisciplinary approaches, including the appropriate correction of fluid and electrolyte imbalances, chemical dissolution, and endoscopic and surgical treatments.
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Affiliation(s)
- Woo Rim Kang
- Department of Internal Medicine, Chonnam National Medical School, Gwangju, Korea
| | - Seon-Young Park
- Department of Internal Medicine, Chonnam National Medical School, Gwangju, Korea
| | - Hye-Su You
- Department of Internal Medicine, Chonnam National Medical School, Gwangju, Korea
| | - Dong Hyun Kim
- Department of Internal Medicine, Chonnam National Medical School, Gwangju, Korea
| | - Chang Hwan Park
- Department of Internal Medicine, Chonnam National Medical School, Gwangju, Korea
| | - Sung Kyu Choi
- Department of Internal Medicine, Chonnam National Medical School, Gwangju, Korea
| | - Hyun-Soo Kim
- Department of Internal Medicine, Chonnam National Medical School, Gwangju, Korea
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Lu D, Berglund B, Xia Y, Jain A, Gu Q, Ji F. Endoscopic removal of a massive trichobezoar in a pediatric patient by using a variceal ligator cap: A case report and literature review. Front Med (Lausanne) 2022; 9:1020648. [PMID: 36405578 PMCID: PMC9673752 DOI: 10.3389/fmed.2022.1020648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/12/2022] [Indexed: 09/28/2023] Open
Abstract
A trichobezoar is commonly formed in the gastrointestinal tract by ingestion of an individual's own hair. A trichobezoar formed by hair and artificial materials constitutes a rare etiology scarcely reported in the current literature. A mixture with hair-like synthetic fibers not only increases the risk for trichobezoar formation but also makes it more difficult for endoscopic removal. Herein, we report on a case in which a trichobezoar, caused by the consumption of human hair and synthetic yarn, was successfully removed endoscopically with a variceal ligator cap without further complications for the patient. This case report aims to raise awareness among endoscopists that using a variceal ligator cap may be a suitable option in the management of large trichobezoars containing synthetic fibers.
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Affiliation(s)
- Dan Lu
- Department of Endoscopy Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Björn Berglund
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Yi Xia
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ajay Jain
- Meridian Medical Group, Indiana University Health Methodist Hospital, Indianapolis, IN, United States
| | - Qing Gu
- Department of Endoscopy Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Feng Ji
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Malick A, Shen B. Endoscopic Treatment of Postoperative Bleeding, Bezoars, and Foreign Bodies. Gastrointest Endosc Clin N Am 2022; 32:829-843. [PMID: 36202519 DOI: 10.1016/j.giec.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Altered gastrointestinal anatomy is common in patients with inflammatory bowel disease, particularly in those who underwent bowel surgery. Commonly performed surgeries are bowel resection and anastomosis and strictureplasty for Crohn's disease; and restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis. The area of anastomosis and suture line is at the greatest risk for the development of postoperative bleeding. Altered bowel anatomy, especially the presence of strictures, strictureplasty, or structural or functional pouch outlet obstruction, puts these patients at risk for bezoar formation and foreign body retention, including video endoscopy capsule. This article will focus on postoperative bleeding, bezoar formation, and video capsule retention in patients with inflammatory bowel disease. Endoscopic management of these conditions is useful and is becoming an increasingly popular alternative to surgery.
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Affiliation(s)
- Alyyah Malick
- Department of Medicine, Columbia University Irving Medical Center-New York Presbyterian Hospital, 622 W 168th St, New York, NY 10032, USA.
| | - Bo Shen
- Center for Inflammatory Bowel Disease, Columbia University Irving Medical Center-NewYork Presbyterian Hospital, 161 Fort Washington Avenue, 8th Floor, New York, NY 10032, USA
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Novel endoscopic tangential sawing technique in treatment of giant gastric bezoars: a retrospective single-center study (with video). Gastrointest Endosc 2022; 96:150-154. [PMID: 35016893 DOI: 10.1016/j.gie.2021.12.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/29/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The current methods for treatment of giant gastric bezoars mainly include chemical dissolution, endoscopic fragmentation, and surgical removal, which often have limited curative effects or generate multiple adverse events. Therefore, there is an urgent need to find new methods to overcome such a dilemma. The aim of this study was to evaluate the safety, efficacy, and feasibility of a novel guidewire-based tangential sawing fragmentation (GTSF) technique to treat giant gastric bezoars. METHODS This retrospective single-center study was performed in the Department of Gastroenterology and Hepatology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital. Ten patients with giant bezoars were consecutively enrolled from December 8, 2019 to April 8, 2021. We treated the 10 patients with the GTSF technique, recorded the GTSF procedure, and followed the patients with gastroscopy 2 weeks after the procedure. RESULTS All patients were successfully treated by the GTSF technique, and the giant bezoar was broken into small pieces (<2 cm in diameter). The average operation time was 21.73 minutes, and the average fragmentation time was 8.06 minutes. Ten patients treated with the GTSF technique attained satisfactory treatment results, with no acute adverse events or alimentary canal injury during the procedure, and no bezoar residue remained as shown by gastroscopy 2 weeks after the procedure. CONCLUSIONS The GTSF technique is a safe, effective, and feasible method for removing giant bezoars and can be considered as an alternative treatment of this disease.
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Mooghal M, Ahmad A, Safi A, Khan W, Ahmad N. Impending perforation near ileocecal junction due to phytobezoar impaction and intraluminal polyp: a case report. J Med Case Rep 2022; 16:124. [PMID: 35351198 PMCID: PMC8966213 DOI: 10.1186/s13256-022-03356-0] [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] [Received: 12/18/2021] [Accepted: 03/03/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Bezoars and polyps are an uncommon cause of mechanical intestinal obstruction. There are four different kinds of bezoars: phytobezoars, made of vegetables and fibers; trichobezoars, resulting from the ingestion of hair and frequently an expression of psychiatric disorders; lactobezoars, which are formed of milk curd; and pharmacobezoars, caused by drugs and medications. Signs and symptoms classically vary from abdominal pain to constipation, nausea, vomiting, and abdominal distension. We present a rare case of impending perforation along with an intraluminal polyp near ileocecal junction due to phytobezoar impaction. Case presentation Our patient was a 59-year-old Sindhi female with a known history of interstitial lung disease and hypertension who presented to the emergency department with complaints of abdominal pain and constipation for 1 week, vomiting for 5 days, and abdominal distension for 2 days. After a preoperative examination and her failure to respond to conservative therapy, she was taken to the operating room for exploratory laparotomy. A hard intraluminal mass was suspected to be obstructing the small bowel at the site of impending perforation. This mass was a phytobezoar along with an intraluminal polyp. Resection of the affected segment was performed, followed by ileoileal anastomosis, and a drain was left. The patient was discharged 1 week later and was found to be well with no complaints at 3 weeks follow-up. Conclusions Early diagnosis of bezoars is important for early intervention and prevention of complications. Our case is unique as phytobezoar with intraluminal polyp is a rare clinical finding. Moreover, the signs and symptoms with which the patient presented are nonspecific and can be seen with multiple surgical emergencies.
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Hu T, Zhang J, Liu Y, Chen L, Cen W, Wu W, Huang Q, Sun X, Stock S, Zippi M, Zimmer V, Basharat Z, Hong W. Evaluation of the risk factors for severe complications and surgery of intestinal foreign bodies in adults: a single-center experience with 180 cases. Gastroenterol Rep (Oxf) 2022; 10:goac036. [PMID: 35966628 PMCID: PMC9366183 DOI: 10.1093/gastro/goac036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/17/2022] [Accepted: 05/20/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Foreign bodies (FBs) lodged in the intestine or causing intestinal complications are uncommon in clinical practice but may pose diagnostic difficulties and prove life-threatening. This study aimed to evaluate the risk factors for severe complications and surgery to aid clinicians in the diagnosis and management of intestinal FBs. METHODS We performed a retrospective analysis of patients in whom FBs were lodged in the intestine or caused complications from 2010 to 2020 in the First Affiliated Hospital of Wenzhou Medical University (Zhejiang, China). The characteristics of the patients and FBs, symptoms, imaging findings, diagnostics, treatment strategies, and clinical outcomes were analysed. Furthermore, the risk factors for complications and surgery were investigated. RESULTS In total, 180 patients were included in our study. Most patients (76.1%) were unable to provide a history of ingestion. Bezoars were the most common FBs (35.6%). The FBs were mainly located in the duodenum (32.8%) and the ileum (27.8%). Surgical removal of FBs was successful in 89 (49.4%) patients and endoscopic removal in 54 (30.0%) patients. Eleven with perforations were treated conservatively. FBs located in the jejunum or ileum were more likely to cause severe complications than those located in the duodenum. FBs located in the jejunum, ileum, or sigmoid colon were more likely to undergo surgery, and severe complications were an independent risk factor for surgery. CONCLUSION Intestinal FBs, often localized in angulation, are likely to be misdiagnosed because most patients do not provide a history of FB ingestion. Surgery and endoscopic therapy are the most commonly used treatment modalities. Surgery is not mandatory in clinically stable patients with small and contained perforations. FBs located in the jejunum or ileum are risk factors for both complications and surgery.
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Affiliation(s)
| | | | | | - Lifang Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P. R. China
| | - Wei Cen
- The First Clinical College, Wenzhou Medical University, Wenzhou, Zhejiang, P. R. China
| | - Wenzhi Wu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P. R. China
| | - Qingke Huang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P. R. China
| | - Xuecheng Sun
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P. R. China
| | - Simon Stock
- Department of Surgery, World Mate Emergency Hospital, Battambang, Cambodia
| | - Maddalena Zippi
- Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome, Italy
| | - Vincent Zimmer
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Zarrin Basharat
- Jamil-ur-Rahman Center for Genome Research, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Wandong Hong
- Corresponding author. Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325025, Zhejiang, P. R. China. Tel: +86-577-88069817; Fax: +86-577-88069555; ;
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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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13
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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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14
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Wang TT, He JJ, Liu J, Chen WW, Chen CW. Acute pancreatitis and small bowel obstruction caused by a migratory gastric bezoar after dissolution therapy: A case report. World J Clin Cases 2021; 9:3114-3119. [PMID: 33969098 PMCID: PMC8080734 DOI: 10.12998/wjcc.v9.i13.3114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/08/2021] [Accepted: 03/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Bezoars are conglomerates of indigestible foreign material that can be found in the gastrointestinal tract. Gastric ulcer, gastrointestinal perforation, and intestinal obstruction are the main complications. Acute pancreatitis secondary to bezoar is rare. Here, we present a rare case of a migratory gastric bezoar complicated by acute pancreatitis and small bowel obstruction after dissolution therapy.
CASE SUMMARY A-65-year-old woman underwent gastroscopy because of epigastric pain, which revealed a huge bezoar and a gastric ulcer 10 d prior. The patient was discharged with a prescription of drinking 1 L Coca-Cola daily for 6 d, without repeat gastroscopy. However, she suddenly developed epigastric pain, nausea and vomiting for 3 d. Abdominal computed tomography (CT) revealed mild inflammation of the pancreas. Magnetic resonance cholangiopancreatography showed no abnormalities in the pancreatic duct or common bile duct. The nasogastric tube still showed drainage of more than 1.6 L of dark fluid each day after symptomatic treatment. Abdominal CT re-examination suggested intestinal obstruction. Esophagogastroduodenoscopy revealed a huge yellowish hard mass in the jejunal lumen, and we used the basket and net to fragment the bezoar. She was discharged with a good outcome.
CONCLUSION Endoscopic therapy is the first choice for gastric bezoars. When mechanical disintegration cannot be achieved, timing of repeat endoscopy is important during Coca-Cola dissolution therapy.
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Affiliation(s)
- Ting-Ting Wang
- Department of Gastroenterology, The First Clinical Medical College, Dalian Medical University, Dalian 116044, Liaoning Province, China
| | - Jia-Jun He
- Department of Gastroenterology, The First Clinical Medical College, Dalian Medical University, Dalian 116044, Liaoning Province, China
| | - Jun Liu
- Endoscopy Center, Department of Gastroenterology, Clinical Medical College, Yangzhou University, Yangzhou 225009, Jiangsu Province, China
| | - Wei-Wei Chen
- Endoscopy Center, Department of Gastroenterology, Clinical Medical College, Yangzhou University, Yangzhou 225009, Jiangsu Province, China
| | - Chao-Wu Chen
- Endoscopy Center, Department of Gastroenterology, Clinical Medical College, Yangzhou University, Yangzhou 225009, Jiangsu Province, China
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15
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Tabesh E, Dehghan A, Tahmasebi M, Javadi N. Gastric phytobezoars as a very unusual cause of gastric outlet obstruction. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2021; 26:25. [PMID: 34221054 PMCID: PMC8240542 DOI: 10.4103/jrms.jrms_115_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/15/2020] [Accepted: 12/22/2020] [Indexed: 11/04/2022]
Abstract
Bezoars are collections of indigestible foreign material found in the gastrointestinal tract. Phytobezoars are the most common among the types of bezoars. Treatment of phytobezoars is categorized into four types: chemical dissolution, endoscopic removal, adjuvant prokinetics, and surgery. Complications from phytobezoars can include gastric outlet obstruction (GOO), ileus, ulcerations, gastrointestinal bleeding, and perforation. Herein, we present an 86-year-old woman with refractory postprandial vomiting. Then, exploratory laparotomy was performed and the diagnosis was gastric phytobezoar. Phytobezoars-induced GOO is rare and its diagnosis is still a challenge.
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Affiliation(s)
- Elham Tabesh
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amin Dehghan
- Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzieh Tahmasebi
- Health Information Technology Research Center, Clinical Informationist Research Group, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Niloofar Javadi
- Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Liu LN, Wang L, Jia SJ, Wang P. Clinical Features, Risk Factors, and Endoscopic Treatment of Bezoars: A Retrospective Analysis from a Single Center in Northern China. Med Sci Monit 2020; 26:e926539. [PMID: 33027245 PMCID: PMC7549533 DOI: 10.12659/msm.926539] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background The aims of this study were to summarize the clinical characteristics and risk factors for bezoars and to analyze the effectiveness and safety of the endoscopic treatment of bezoars. Material/Methods From January 2015 to February 2020, 75 of the 23 950 patients who underwent gastroscopic examination in our medical center were diagnosed with bezoars. Clinical and treatment information for these patients was collected retrospectively and analyzed. Results The detection rate of bezoars was 0.31%. Risk factors included the time of year (autumn and winter seasons), alcohol consumption, hypertension, diabetes, and residing in the Mentougou district, which is rich in hawthorn and persimmon. Abdominal pain (90.7%) and bloating (80.0%) were common clinical symptoms of bezoars, while gastric mucosa erosion (90.7%) and gastric ulcers (60%) were common manifestations on endoscopic examination. Six patients with bezoars were successfully discharged after drug treatment. The success rate for bezoars treated by gastroscopic lithotripsy was 94.2% (65/69 patients). The factors affecting the therapeutic effect of bezoars include patient age (P=0.025) and bezoar size (P=0.042). Patients with bezoars larger than 9 cm were significantly more likely to have intestinal obstructions than were patients with bezoars smaller than 9 cm (P<0.001). Conclusions Bezoars mainly occur in elderly patients with diseases such as gastrointestinal dyspraxia and diabetes, and are most common in hawthorn and persimmon producing areas. Endoscopic treatment is safe and effective for bezoars in general, but intestinal obstruction should be considered for bezoars larger than 9 cm.
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Affiliation(s)
- Lin-Na Liu
- Department of Gastroenterology, Peking University Shougang Hospital, Beijing, China (mainland)
| | - Lei Wang
- Department of Urology, Peking University Shougang Hospital, Beijing, China (mainland).,Peking University Wujieping Urology Center, Peking University Health Science Center, Beijing, China (mainland)
| | - Shu-Juan Jia
- Department of Gastroenterology, Peking University Shougang Hospital, Beijing, China (mainland)
| | - Peng Wang
- Department of Gastroenterology, Peking University Shougang Hospital, Beijing, China (mainland)
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17
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Abstract
Trichobezoars are masses of ingested hair, usually the individual's own hair, that accumulate in the gastrointestinal tract, most commonly in the stomach. When extending into the small intestine, this is termed "Rapunzel syndrome." Removal has traditionally been by laparotomy; however, successful endoscopic removal has also been described. We report the case of a 9-year-old-girl with undiagnosed coeliac disease and Rapunzel syndrome who underwent endoscopic removal of a large trichobezoar, which was followed by unexpected multiple perforations of the small bowel and stomach. Argon plasma coagulation (APC) and snare electrocautery were employed during endoscopy to remove the trichobezoar piecemeal, and approximately 70% was removed without any clear signs of damage to the mucosa. It was discovered subsequently that about 20 of her dolls were found without hair. On investigating the composition of a specific doll hair from the manufacturer, it was discovered that it could be hazardous if burned. It was, therefore, hypothesized that a constellation of factors had conspired to lead to perforation, that is, the potentially hazardous gas produced from the electrical energy applied to the synthetic hair and possible mucosal damage by the physical abrasion of this hair. A review of the literature on endoscopic attempts to remove trichobezoars irrespective of the result reveals a success rate of 30.7%.
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18
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Lithobezoar: A Case Report and Literature Review of an Infrequent Cause of Abdominal Pain. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2020; 53:445-449. [PMID: 32377125 PMCID: PMC7192304 DOI: 10.14744/semb.2018.52714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/19/2018] [Indexed: 11/20/2022]
Abstract
A bezoar is the accumulation of indigestible substances in the gastrointestinal system. Presently described is the case of a 47-year-old male patient who was admitted to the clinic with nausea, vomiting, pain, and abdominal distension. He had a medical history of obsessive-compulsive disorder. He had begun eating soil in the previous 3 to 4 months. Gastroscopy revealed a large, solid, clay-like mass in the stomach. Surgery was successfully performed to remove the collected soil, but unfortunately, the patient died due to an acute myocardial infarction on the postoperative fourth day. Physicians should keep bezoars in mind in cases of unexplained abdominal symptoms, especially in females and patients with psychiatric disorders. Psychiatric disorders are often ignored by surgeons during examinations, which can lead to serious and life-threatening complications.
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Gökbulut V, Kaplan M, Kaçar S, Kayhan MA, Coşkun O, Kayaçetin E. Bezoar in upper gastrointestinal endoscopy: A single center experience. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2020; 31:85-90. [PMID: 32141815 PMCID: PMC7062142 DOI: 10.5152/tjg.2020.18890] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/22/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND/AIMS We aimed to investigate the association of bezoar with endoscopic findings, risk factors for bezoar occurrence, and the success of endoscopic treatment in a tertiary center. MATERIALS AND METHODS This retrospective study was conducted between January 2012 and December 2015. Overall, 8200 endoscopy records were examined and 66 patients with bezoar were included in the study. RESULTS We enrolled 29 (44%) female and 37 (56%) male patients in this study. The mean age of the patients was 63±9.4 years. The most frequent risk factors were history of gastrointestinal surgery (23%), diabetes mellitus (17%), trichophagia (9%), and anxiety disorder (6%). Gastric ulcer, duodenal ulcer, erosive gastritis, and reflux esophagitis were present in 27%, 11%, 20%, and 23% of the patients, respectively. While bezoars were most commonly observed in the stomach (70%), the majority of them were phytobezoars (91%). The mean number of interventions for each patient was 1.5 (range, 1-6). Endoscopy was successful in removing bezoars in 86.5% of the patients. Among those referred to surgery, seven patients underwent gastrostomy (10.5%); one (1.5%) patient underwent gastroenterostomy because of concomitant pyloric stenosis; and one (1.5%) patient underwent fistula repair surgery due to the development of duodenal fistula caused by bezoar. CONCLUSION The findings of this study indicated that bezoars are more common among subjects with history of gastrointestinal surgery, diabetes mellitus, or psychiatric disorders; bezoars are closely related to peptic ulcer and reflux esophagitis; and they can be successfully treated with endoscopy.
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Affiliation(s)
- Volkan Gökbulut
- Department of Gastroenterology, Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - Mustafa Kaplan
- Department of Gastroenterology, Ahi Evran University Training and Research Hospital, Kırşehir, Turkey
| | - Sabite Kaçar
- Department of Gastroenterology, Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - Meral Akdoğan Kayhan
- Department of Gastroenterology, Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - Orhan Coşkun
- Department of Gastroenterology, Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - Ertuğrul Kayaçetin
- Department of Gastroenterology, Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
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20
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Oka A, Ishihara S, Mikami H, Sonoyama H, Mishiro T, Tobita H, Kawashima K, Miyake T, Ishimura N, Furuta K, Kinoshita Y, Nishina M. Retained Rice Cake: A Unique Upper Gastrointestinal Foreign Body: Case Report and a Literature Review. Intern Med 2019; 58:2485-2494. [PMID: 31178509 PMCID: PMC6761341 DOI: 10.2169/internalmedicine.2760-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
As a rarely recognized foreign body in the upper gastrointestinal tract, rice cake frequently requires endoscopic removal. We herein report six patients with characteristic sonography, computed tomography (CT), spectroscopy, endoscopy, and histological findings. A review of all published cases, including ours, revealed that retained rice cake in the stomach typically shows the following: abdominal pain (93.3%), mucosal injury (93.3%) with bleeding (42.9%); high-density (120-206 Hounsfield units) CT findings; and indication for endoscopy (80%). In the esophagus, hot, toasted rice cake causes thermal injury. Primary physicians should be aware of this popular-food-induced, but rare, disorder.
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Affiliation(s)
- Akihiko Oka
- Department of Emergency and Critical Care Medicine, Shimane University, Faculty of Medicine, Japan
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
- Center for Gastrointestinal Biology and Disease, Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, USA
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
- Inflammatory Bowel Disease Center, Shimane University Hospital, Japan
| | - Hironobu Mikami
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
- Division of Gastroenterology, National Hospital Organization Hamada Medical Center, Japan
| | - Hiroki Sonoyama
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
| | - Tsuyoshi Mishiro
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
- Division of Gastroenterology, National Hospital Organization Hamada Medical Center, Japan
| | - Hiroshi Tobita
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
| | - Kousaku Kawashima
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
- Inflammatory Bowel Disease Center, Shimane University Hospital, Japan
| | - Tatsuya Miyake
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
- Division of Hepatology, Shimane Prefectural Central Hospital, Japan
| | - Norihisa Ishimura
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
| | - Kenji Furuta
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
- Otsu Internal Medicine Clinic, Japan
| | - Yoshikazu Kinoshita
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
| | - Masayoshi Nishina
- Department of Emergency and Critical Care Medicine, Shimane University, Faculty of Medicine, Japan
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21
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Al-Mouakeh A, Shashaa MN, Brimo Alsaman MZ, Zazo A, Alkarrash MS, Zazo R, Niazi A. Trichobezoar in a young girl caused by ingestion of bristles brush for more than a decade: A case report. Int J Surg Case Rep 2019; 61:48-50. [PMID: 31323484 PMCID: PMC6637247 DOI: 10.1016/j.ijscr.2019.05.045] [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: 04/08/2019] [Accepted: 05/20/2019] [Indexed: 11/25/2022] Open
Abstract
Ingestion of hair and bristle brush led to unique type of trichobezoars. Trichobezoars led to gastric outlet obstruction. The diagnosis is made by abdominal X-ray, computed tomography scan and endoscopic examination. Surgical intervention is performed for the majority of patients.
Introduction Trichobezoar is a rare cause of bowel obstruction. In general, Trichobezoars are composed of hair and usually found incidentally in patients undergoing upper gastrointestinal endoscopy or imaging. Patients diagnosed with Trichobezoar may have psychiatric disorders. Discussion Trichobezoars cause nonspecific symptoms like asymptomatic abdominal mass, vomiting, nausea, and anorexia. Diagnosis of Trichobezoar is made by endoscopic examination and radiological methods. Therapeutic options for trichobeazoar are chemical dissolution, endoscopic removal or surgery. Case presentation Here we present a case of an 18-year-old girl who has a unique type of Trichobezoars caused by ingestion of hair and bristle clothes brush for 14 years. She presented to the surgical clinic complaining of vomiting, anorexia and epigastric mass. Abdominal computed tomography scanner showed nonattached intragastric mass which was consistent with trichobezoar. The patient was managed by surgical removal of the intragastric mass. Conclusion Trichobezoar is caused by chronic ingestion of hair; it is commonly seen in young females who may have psychological disorders, such as trichophagia and trichotillomania. Common symptoms are abdominal pain, nausea, vomiting, and weight loss. Surgical intervention is performed for the majority of the patients.
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Affiliation(s)
| | | | | | - Aya Zazo
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | | | - Rama Zazo
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Ammar Niazi
- Surgery Department, Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syria
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22
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A Bezoar Composed of Bilirubin Calcium, Calcium Carbonate, and Fatty Acid Calcium. Case Rep Gastrointest Med 2019; 2019:5742672. [PMID: 31240139 PMCID: PMC6556286 DOI: 10.1155/2019/5742672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/24/2019] [Accepted: 05/07/2019] [Indexed: 01/01/2023] Open
Abstract
A 68-year-old Japanese man was diagnosed with bezoar in the stomach, which was endoscopically retrieved. The bezoar was composed of bilirubin calcium, calcium carbonate, and fatty acid calcium. Due to the presence of bilirubin calcium in the bezoar, we performed imaging studies of the bile duct; gallstones and common bile duct stones were identified. Although bezoar with components similar to bile is infrequently encountered, our findings suggest that a bezoar originating from bile should be considered among the differential diagnoses in patients without a recent consumption history of persimmons who demonstrate a mass in the digestive tract. This case highlights the importance of component analysis of gastric bezoars because its findings may alter the treatment plan.
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23
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Paschos KA, Chatzigeorgiadis A. Pathophysiological and clinical aspects of the diagnosis and treatment of bezoars. Ann Gastroenterol 2019; 32:224-232. [PMID: 31040619 PMCID: PMC6479654 DOI: 10.20524/aog.2019.0370] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/11/2019] [Indexed: 12/18/2022] Open
Abstract
Bezoars are intraluminal conglomerates of indigestible foreign materials that accumulate in the gastrointestinal (GI) tract. They consist of vegetable or fruit fibers, hairs or other substances; accordingly, bezoars are classified as phytobezoars, trichobezoars, pharmacobezoars, etc. Although sometimes asymptomatic, bezoars may cause serious symptoms, such as abdominal discomfort or pain, dysphagia, hematemesis, or even life-threatening entities (GI bleeding, obstruction or perforation). Current technological applications have contributed to the diagnostic and therapeutic approach to these masses, mainly through endoscopic techniques able to diagnose, fragment and extract bezoars, as well as laparoscopic and other surgical modalities that may be used to treat serious complications. Although bezoars were described centuries ago and the term was officially introduced in the mid nineties by Quain, they are still a demanding pathological entity. Their pathophysiology, accurate and prompt diagnosis, as well as successful and minimally invasive treatment, remain under investigation and see continuous progress. Current advances in these challenging areas are discussed in this review, which attempts to present an in-depth study of bezoars along with the well-established modalities and techniques.
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24
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Sugimoto S, Shimono T, Takeshita T, Yamamoto A, Shindo D, Miki Y. Clinical and CT findings of small bowel obstruction caused by rice cakes in comparison with bezoars. Jpn J Radiol 2019; 37:301-307. [PMID: 30649674 DOI: 10.1007/s11604-019-00811-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 01/10/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Rice cakes have not been recognized as a cause of small bowel obstruction (SBO) worldwide. We compared clinical and CT findings of rice cake SBO versus SBO due to bezoars, the most common cause of food-induced SBO. METHODS Twenty-four patients with rice cake SBO (n = 17) or bezoar SBO (n = 7) were retrospectively evaluated for clinical findings and the following multi-detector CT (MDCT) features: identification of the transition zone, presence of intraluminal lesions, degree of obstruction, and length and attenuation of obstructing materials. Categorical variables were compared by Fisher's exact test, and continuous variables by independent t test. RESULTS None of the rice cake SBO patients required surgery, whereas 4/7 (57%) bezoar SBO patients underwent surgery. On MDCT, rice cake residues were recognized as well-defined intraluminal lesions of shorter length (29.8 ± 4.6 mm vs. 47.7 ± 10.8 mm for bezoars; p < 0.0001) and higher attenuation (106 ± 27.8 HU vs. - 62.8 ± 14.7 HU for bezoars; p < 0.0001). CONCLUSIONS Rice cake SBO patients did not require surgery. On MDCT, rice cake residues were significantly shorter and higher in attenuation than bezoars. These findings facilitate diagnosis and support the conservative management of rice cake SBO.
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Affiliation(s)
- Shigehiro Sugimoto
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-cho, Abeno-ku, Osaka, Osaka, 545-8585, Japan.
| | - Taro Shimono
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-cho, Abeno-ku, Osaka, Osaka, 545-8585, Japan
| | - Tohru Takeshita
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-cho, Abeno-ku, Osaka, Osaka, 545-8585, Japan
| | - Akira Yamamoto
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-cho, Abeno-ku, Osaka, Osaka, 545-8585, Japan
| | - Daisuke Shindo
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-cho, Abeno-ku, Osaka, Osaka, 545-8585, Japan
| | - Yukio Miki
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-cho, Abeno-ku, Osaka, Osaka, 545-8585, Japan
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25
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Iwamuro M, Yamauchi K, Shiraha H, Okada H. All carbonated beverages effectively dissolve phytobezoars. Clin Res Hepatol Gastroenterol 2018; 42:e66-e67. [PMID: 29903611 DOI: 10.1016/j.clinre.2018.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 01/29/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-Ku, Okayama 700-8558, Japan.
| | - Kenji Yamauchi
- Department of Gastroenterology, Mitoyo General Hospital, Kan-onji 769-1695, Japan
| | - Hidenori Shiraha
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-Ku, Okayama 700-8558, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-Ku, Okayama 700-8558, Japan
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26
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Au VA, Wong JP, Venu I, Moodie RG, Etoom Y, Kieswetter L, Gerstle JT, Wong PD. Failing to thrive, abdominal pain and vomiting: A hairy situation. Paediatr Child Health 2018; 23:173-175. [PMID: 29773958 DOI: 10.1093/pch/pxx210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Victoria A Au
- Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Jonathan P Wong
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario.,Department of Paediatrics, Hospital for Sick Children, Dublin, Irel
| | - Isvarya Venu
- Trinity College, University of Dublin, Dublin, Irel
| | - Rosemary G Moodie
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario.,Department of Paediatrics, Hospital for Sick Children, Dublin, Irel
| | - Yousef Etoom
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario.,Department of Paediatrics, Hospital for Sick Children, Dublin, Irel.,Department of Paediatrics, St. Joseph's Health Centre, Toronto, Ontario
| | - Luke Kieswetter
- Department of Paediatrics, McMaster University, Toronto, Ontario
| | - J Ted Gerstle
- Department of Surgery, Hospital for Sick Children, Toronto, Ontario
| | - Peter D Wong
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario.,SickKids Research Institute, Toronto, Ontario
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27
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Horesh N, Rosin D, Dreznik Y, Amiel I, Jacoby H, Nadler R, Gutman M, Klang E. A Single Tertiary Center 10-Year Experience in the Surgical Management of Gastrointestinal Bezoars. J Laparoendosc Adv Surg Tech A 2018; 28:967-971. [PMID: 29641363 DOI: 10.1089/lap.2017.0752] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Gastrointestinal (GI) bezoars are the most common foreign bodies causing obstruction in the GI tract. They are frequently seen following upper GI tract surgery and surgical intervention is required often. The aim of this study is to describe the surgical management of GI bezoars. MATERIALS AND METHODS A retrospective cohort study, including all patients diagnosed with bezoars between May 2008 and May 2017, was conducted. Patient charts were reviewed, and demographics, clinical, surgical, and postoperative data were collected and analyzed. RESULTS Forty-five patients were included, with a mean age of 62.04 years (Range 18-91). Thirty patients underwent previous surgery (66.6%), most commonly surgical interventions for peptic ulcer disease (22 patients, 73.3%). Obstruction was most common in the ileum (27 patients, 60%). Thirty-nine patients (86.7%) required surgical intervention. Laparoscopy was attempted in 20 patients (51.2%), but conversion to open procedure was required in 11 patients (55%). Postoperative complication rate was 41%. No preoperative factors were found to be correlated with postoperative complications. Postoperative complications were associated with a longer length of stay (P = .006) and a higher readmission rate (P = .04). Patients treated with laparoscopy tended to have a lower BMI (P = .04), less previous surgeries (P = .04), and a bezoar located more proximally (P = .03), however, laparoscopy showed no benefit in complications rate, readmissions, and length of stay. CONCLUSIONS GI bezoars require surgical intervention at high rates. Postoperative complications are common. Completion of an upper GI endoscopy is important and should be performed at an early stage of management.
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Affiliation(s)
- Nir Horesh
- 1 Department of General Surgery and Transplantations, Tel Aviv University , Ramat Gan, Israel
| | - Danny Rosin
- 1 Department of General Surgery and Transplantations, Tel Aviv University , Ramat Gan, Israel
| | - Yael Dreznik
- 1 Department of General Surgery and Transplantations, Tel Aviv University , Ramat Gan, Israel
| | - Imri Amiel
- 1 Department of General Surgery and Transplantations, Tel Aviv University , Ramat Gan, Israel
| | - Harel Jacoby
- 1 Department of General Surgery and Transplantations, Tel Aviv University , Ramat Gan, Israel
| | - Roy Nadler
- 1 Department of General Surgery and Transplantations, Tel Aviv University , Ramat Gan, Israel
| | - Mordechai Gutman
- 1 Department of General Surgery and Transplantations, Tel Aviv University , Ramat Gan, Israel
| | - Eyal Klang
- 2 Department of Radiology, Chaim Sheba Medical Center, affiliated with The Faculty of Medicine, Tel Aviv University , Ramat Gan, Israel
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28
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Endo K, Kakisaka K, Suzuki Y, Matsumoto T, Takikawa Y. Obstructive Bezoars of the Small Bowel Treated with Coca-Cola Zero through a Long Intestinal Tube and Endoscopic Manipulation. Intern Med 2017; 56:3019-3022. [PMID: 28943577 PMCID: PMC5725854 DOI: 10.2169/internalmedicine.8922-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
An 82-year-old Japanese man visited our hospital with abdominal fullness accompanied by lower abdominal pain. He presented with small bowel obstruction due to multiple diospyrobezoars. The bezoars were successfully removed without any surgical intervention by the administration of Coca-Cola Zero through a long intestinal tube and subsequent endoscopic manipulation. Such a combination may be the treatment of choice for small bowel obstruction due to bezoars.
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Affiliation(s)
- Kei Endo
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Japan
| | - Keisuke Kakisaka
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Japan
| | - Yuji Suzuki
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Japan
| | - Yasuhiro Takikawa
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Japan
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Appleton ES, Lee NA, Ford AC. Multiple myeloma presenting in association with gastric phytobezoar. Clin Case Rep 2017; 5:1493-1495. [PMID: 28878912 PMCID: PMC5582312 DOI: 10.1002/ccr3.1104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 05/10/2017] [Accepted: 06/25/2017] [Indexed: 01/27/2023] Open
Abstract
We present a rare case of a patient with delayed gastric emptying, gastric phytobezoar formation, and osteosclerotic bone lesions as an atypical association with multiple myeloma. Associated gastric features in myeloma, which include diffuse infiltration, gastric plasmacytomas, or delayed gastric emptying, are rare and have a poor prognosis.
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Affiliation(s)
| | - Natasha A Lee
- Leeds Gastroenterology Institute St. James's University Hospital Leeds UK
| | - Alexander C Ford
- Leeds Gastroenterology Institute St. James's University Hospital Leeds UK.,Leeds Institute of Biomedical and Clinical Sciences University of Leeds Leeds UK
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Affiliation(s)
- Amr Matoq
- 1 University of Florida College of Medicine, Jacksonville, FL, USA
| | - Tiffany Lee
- 1 University of Florida College of Medicine, Jacksonville, FL, USA
| | - Asma Salahuddin
- 1 University of Florida College of Medicine, Jacksonville, FL, USA
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Iwamuro M, Tsutsumi K, Okada H. Balloon Dilation and Electrohydraulic Lithotripsy for Treating an Impacted Duodenal Bezoar. Clin Gastroenterol Hepatol 2017; 15:e67-e68. [PMID: 27693648 DOI: 10.1016/j.cgh.2016.09.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Koichiro Tsutsumi
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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Zhao JL, Zhao WC, Wang YS. Endoscopic retrieval of gastric trichophytobezoar: Case report of a 12-year-old girl with trichophagia. Medicine (Baltimore) 2017; 96:e5969. [PMID: 28099364 PMCID: PMC5279109 DOI: 10.1097/md.0000000000005969] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Trichophytobezoars, which are composed of hair and plant fibers, are usually located in the stomach. They are often associated with trichophagia and trichotillomania. The most commonly reported methods of trichophytobezoar treatment are open surgery and laparoscopic retrieval; there are few reports of endoscopic removal of trichophytobezoars. PATIENT CONCERNS AND DIAGNOSES Twelve-year-old girl presented with a 3-day history of increasing upper abdominal pain, anorexia, and postprandial emesis. She had a 3-year history of pulling out and eating her own hair. Endoscopic examination showed a large intragastric trichophytobezoar measuring 10.5 cm × 3.5 cm in size, with extension of a few hairs through the pylorus. INTERVENTIONS AND OUTCOMES The trichophytobezoar was packed with hair fibers and contained a hard core of mixed hair and vegetable fibers. After the core was cut, the trichophytobezoar was fragmented into pieces with the alternating use of a polypectomy snare and argon plasma coagulation. A small amount of hair and nondigestible food fibers was removed with grasping forceps during the initial procedure. The remaining hairball was loosened with biopsy forceps and was injected with sodium bicarbonate solution. The trichophytobezoar was removed completely at repeat endoscopy 5 days later. After 6 months of psychological intervention, the patient had no recurrence of trichophagia or trichophytobezoar. LESSONS Endoscopy with sodium bicarbonate injection is an effective and minimally invasive method of retrieving a gastric trichophytobezoar.
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Affiliation(s)
- Jiu-ling Zhao
- Department of Pediatrics, Tianjin Nankai Hospital
- Nankai Clinical School, Tianjin Medical University
| | - Wei-chuan Zhao
- Department of Endoscopy, Tianjin Nankai Hospital, Nankai, Tianjin, China
| | - Yu-shui Wang
- Department of Pediatrics, Tianjin Nankai Hospital
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The Combination Therapy of Dissolution Using Carbonated Liquid and Endoscopic Procedure for Bezoars: Pragmatical and Clinical Review. Gastroenterol Res Pract 2016; 2016:7456242. [PMID: 27642293 PMCID: PMC5011516 DOI: 10.1155/2016/7456242] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/20/2016] [Accepted: 07/25/2016] [Indexed: 11/18/2022] Open
Abstract
Bezoars are relatively rare foreign bodies of gastrointestinal tract and often cause ileus and ulcerative lesions in the stomach and subsequent bleeding and perforation due to their size and stiffness. Therefore, the removal of bezoars is essential and recent development of devices, the endoscopic removal procedure, is often applied. However, due to their stiffness, simple endoscopic removal failed in not a few cases, and surgical removal has also been used. Recently, the efficacy of a combination therapy of endoscopic procedure and dissolution using carbonated liquid has been reported. To develop the safe and effective removal procedure, we carefully reviewed a total of 55 reported cases in this study including our 3 additional cases, successfully treated with dissolution with endoscopic fragmentation. In summary, the data showed the efficiency in the combination therapy, treating the larger size of bezoar and reducing the length of hospital stay. To the best of our knowledge, this is the largest pragmatical and clinical review for the combination therapy of dissolution and endoscopic treatment for bezoars. This review should help physicians to manage bezoars more efficiently.
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Iwamuro M, Urata H, Higashi R, Nakagawa M, Ishikawa S, Shiraha H, Okada H. An Energy Dispersive X-ray Spectroscopy Analysis of Elemental Changes of a Persimmon Phytobezoar Dissolved in Coca-Cola. Intern Med 2016; 55:2611-5. [PMID: 27629955 DOI: 10.2169/internalmedicine.55.6985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
To investigate the mechanism of phytobezoar dissolution by Coca-Cola(®), persimmon phytobezoar pieces removed from a 60-year-old Japanese woman were analyzed by energy dispersive X-ray spectroscopy. The amount of calcium significantly decreased after dissolution treatment using Coca-Cola(®), suggesting a potential contribution of calcium to dissolution mechanisms. Moreover, immersion in Coca-Cola(®) for 120 hours on the exterior surface revealed that Coca-Cola(®) did not permeate persimmon phytobezoars. This is the first study to investigate the mechanisms of persimmon phytobezoar permeability and dissolution induced by Coca-Cola(®).
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Affiliation(s)
- Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
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Iwamuro M, Yunoki N, Tomoda J, Nakamura K, Okada H, Yamamoto K. Gastric Bezoar Treatment by Endoscopic Fragmentation in Combination with Pepsi-Cola® Administration. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:445-8. [PMID: 26164451 PMCID: PMC4504408 DOI: 10.12659/ajcr.893786] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although bezoar dissolution by Coca-Cola® has been described in case reports and case series, to the best of our knowledge, the usefulness of other cola products such as Pepsi-Cola® has never been reported in the English literature. CASE REPORT An 86-year-old Taiwanese man was diagnosed with a gastric bezoar. Endoscopic fragmentation with a polypectomy snare was attempted twice but failed to remove the bezoar. Subsequently, 500 mL of Pepsi NEX Zero® was administered daily for 4 days via nasogastric tube. The bezoar was softened and successfully fragmented by the polypectomy snare and needle-knife devices on the third attempt. CONCLUSIONS This report presents the first case of a gastric bezoar successfully treated by endoscopic fragmentation in combination with Pepsi-Cola® administration, suggesting the possible utility of cola beverages in bezoar treatment, regardless of product brands.
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Affiliation(s)
- Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Naoko Yunoki
- Department of Internal Medicine, Akaiwa Medical Association Hospital, Akaiwa, Japan
| | - Jun Tomoda
- Department of Internal Medicine, Akaiwa Medical Association Hospital, Akaiwa, Japan
| | - Kazuhiro Nakamura
- Department of Internal Medicine, Akaiwa Medical Association Hospital, Akaiwa, Japan
| | - Hiroyuki Okada
- Department of Endoscopy, Okayama University Hospital, Okayama, Japan
| | - Kazuhide Yamamoto
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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Iwamuro M, Okada H, Matsueda K, Inaba T, Kusumoto C, Imagawa A, Yamamoto K. Review of the diagnosis and management of gastrointestinal bezoars. World J Gastrointest Endosc 2015; 7:336-345. [PMID: 25901212 PMCID: PMC4400622 DOI: 10.4253/wjge.v7.i4.336] [Citation(s) in RCA: 164] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 10/19/2014] [Accepted: 01/20/2015] [Indexed: 02/05/2023] Open
Abstract
The formation of a bezoar is a relatively infrequent disorder that affects the gastrointestinal system. Bezoars are mainly classified into four types depending on the material constituting the indigestible mass of the bezoar: phytobezoars, trichobezoars, pharmacobezoars, and lactobezoars. Gastric bezoars often cause ulcerative lesions in the stomach and subsequent bleeding, whereas small intestinal bezoars present with small bowel obstruction and ileus. A number of articles have emphasized the usefulness of Coca-Cola® administration for the dissolution of phytobezoars. However, persimmon phytobezoars may be resistant to such dissolution treatment because of their harder consistency compared to other types of phytobezoars. Better understanding of the etiology and epidemiology of each type of bezoar will facilitate prompt diagnosis and management. Here we provide an overview of the prevalence, classification, predisposing factors, and manifestations of bezoars. Diagnosis and management strategies are also discussed, reviewing mainly our own case series. Recent progress in basic research regarding persimmon phytobezoars is also briefly reviewed.
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Adhikari DR, Vankipuram S, Tiwari AR, Chaphekar AP, Satardey RS. Small intestinal obstruction secondary to jejunal trichobezoar removed per anum without an enterotomy: a case report. J Clin Diagn Res 2015; 9:PD03-4. [PMID: 25954662 DOI: 10.7860/jcdr/2015/11529.5694] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 02/05/2015] [Indexed: 11/24/2022]
Abstract
Trichobezoars can rarely present with obstruction. This is usually due to collection of a hair ball in the stomach. We encountered an interesting case of small bowel obstruction due to a jejunal trichobezoar. The treatment generally is an enterotomy with removal of the hair ball. We report a case of a 29-year-old post partum female who presented to us with sub acute intestinal obstruction. Exploratory laparotomy revealed an impacted mass in the distal jejunum which was removed per anum without an enterotomy. Postoperative gastroscopy did not show trichobezoar in the stomach. This case highlights the importance of trichobezoar as a differential diagnosis in young women with small bowel obstruction that can be treated without an enterotomy and avoiding the risks and morbidities associated with it.
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Affiliation(s)
- Devbrata Radhikamohan Adhikari
- Assistant Professor, Department of General Surgery, Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital , Mumbai, India
| | - Siddharth Vankipuram
- Resident, Department of General Surgery, Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital , Mumbai, India
| | - Ajeet Ramamani Tiwari
- Resident, Department of General Surgery, Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital , Mumbai, India
| | - Aniruddha Prabhakar Chaphekar
- Associate Professor, Department of General Surgery, Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital , Mumbai, India
| | - Ritesh Suresh Satardey
- Resident, Department of General Surgery, Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital , Mumbai, India
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