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De Cesare A, Fiori E, Bononi M, Ferraro D. Phytobezoar-induced small bowel obstruction associated with a concomitant gastric phytobezoar and ulcer in an elderly woman. Ann Ital Chir 2015; 86:70-77. [PMID: 25817461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Bezoars are aggregates of indigested foreign material that accumulate in the gastroenteric tract, expecially in the stomach and in the narrowest points of the small bowel. They often occur in subjects who follow a diet rich in fruit and vegetables and in those one who previously underwent gastric resective surgery for peptic ulcer. Bezoar formation has even been observed in case of reduced gastric motility and secretion due to diabetes, hypothyroidism, pernicious anemia, myotonic syndromes, and Guillain-Barré syndrome. As they are an uncommon cause of small bowel obstruction, phytobezoars are often not considered in the differential diagnosis of occlusive intestinal syndromes and so frequently come as an intraoperative finding. A consequence of this missed diagnosis in the preoperative period is an unnecessary diagnostic delay that can significantly increase morbidity and mortality. This case report illustrates the need to include phytobezoars in the preoperative diagnostic workout of intestinal obstruction in order to rule out the presence of multiple bezoars and prevent recurrent obstruction. Now that phytobezoars are becoming a less infrequent cause of small bowel obstruction than previously thought, such a diagnostic possibility should always be considered.
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Hernández Garcés HR, Moquillaza Muchaypiña JA, Vera Caceres LC, Moutary I, Montalvo Montoya HA, Andrain Sierra Y. [Gastric tricobezoar: a rare cause of tumoral syndrome and pyloric obstruction]. REVISTA DE GASTROENTEROLOGIA DEL PERU : ORGANO OFICIAL DE LA SOCIEDAD DE GASTROENTEROLOGIA DEL PERU 2015; 35:93-96. [PMID: 25875524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED A Trichobezoar is a rare tumoral mass of the gastrointestinal tract, formed mainly from the ingestion of hair. It contains also mucus and foods debris. CASE PRESENTATION A 22 years old female with a 10 years history of surgery secondary to gastric foreign body (trichobezoar), presents with abdominal pain, swelling, nausea and vomiting. Physical examination of the abdomen revealed a palpable mass in the epigastric and left upper quadrant regions. It was also noted areas of alopecia of the scalp. DISCUSSION Ninety percent of the trichobezoars present in females with a high frequency between 10-19 years. The treatment of bezoars (unless small in size) is mainly surgical. A psychiatric evaluation and follow up is important after surgery hence in most cases there is a psychological disorder that lead to the ingestion of hair.
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Turkdogan KA, Yigit M. A rare image phytobezoar in stomach. Pan Afr Med J 2015; 20:32. [PMID: 26029321 PMCID: PMC4441137 DOI: 10.11604/pamj.2015.20.32.5844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 12/13/2014] [Indexed: 11/18/2022] Open
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Tainter CR, Bunch S, Manini AF, Sallustio S, Acharya JK. Dietary practices revealed with radiography: pictures worth a thousand words. J Emerg Med 2014; 47:78-80. [PMID: 24613224 DOI: 10.1016/j.jemermed.2013.11.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 11/18/2013] [Accepted: 11/26/2013] [Indexed: 06/03/2023]
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Bingham JR, Causey MW, Haque MI. Phytobezoar within Meckel's diverticulum: an unusual cause of intestinal obstruction. Am Surg 2014; 80:E94-E96. [PMID: 24666857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Attou R, Reper P. Slow-release clomipramine acute poisoning with radio-opaque gastric bezoar. Intensive Care Med 2013; 39:1320. [PMID: 23620219 DOI: 10.1007/s00134-013-2925-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 04/05/2013] [Indexed: 11/26/2022]
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Thomas R, Spaulding K, Griffin JF. Clinical Snapshot: gastric foreign body in a Doberman pinscher. COMPENDIUM (YARDLEY, PA) 2013; 35:E7. [PMID: 23713178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Pelletier JF, Higgins GL, Haydar SA. Obstipation unresponsive to usual therapeutic maneuvers. THE JOURNAL OF FAMILY PRACTICE 2012; 61:353-355. [PMID: 22670240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Miyamoto K, Minemura A, Watanabe M, Nakamura S, Dohi K, Miyake Y, Aruga T. [Aggressive endoscopic removal of bezoars effective for the treatment of acute poisoning]. CHUDOKU KENKYU : CHUDOKU KENKYUKAI JUN KIKANSHI = THE JAPANESE JOURNAL OF TOXICOLOGY 2012; 25:113-116. [PMID: 22774588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A 37-year-old female presented with acute chlorpromazine and phenobarbital poisoning. Contrast enhanced abdominal CT on admission revealed a high density area at the gastric fundus and residual drugs were suspected. Activated charcoal and cathartics were administered following the gastric lavage under the intubation. As the plasma concentration of phenobarbital was high, urinary alkalinization and crystalloid infusion were carried out to reduce it. However, at 3 days after admission, the plasma concentration level had increased and the consciousness disturbance and respiratory depression continued. Abdominal CT was performed again and bezoars formation was suspected. Endoscopy was carried out to remove the bezoars. After the removal, the plasma concentration level significantly decreased. Her consciousness disturbance and respiratory depression also improved and high density area at the gastric fundus disappeared. Acute endoscopy is seldom advocated in cases of drug overdose. However, aggressive endoscopic removal should be considered in the case of acute poisoning of drugs with form bezoars.
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Kim HC, Yang DM, Kim SW, Park SJ, Ryu JK. Color Doppler twinkling artifacts in small-bowel bezoars. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:793-797. [PMID: 22535727 DOI: 10.7863/jum.2012.31.5.793] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Small-bowel bezoars usually form in the stomach and may subsequently cause small-bowel obstruction. Bezoars associated with small-bowel obstruction have been accurately diagnosed by computed tomography, although some case reports have described the specific sonographic findings of small-bowel bezoars. Bezoars can be overlooked by sonographic examination if a dilated small-bowel loop contains a large amount of air. Twinkling artifacts on color Doppler images appear as rapidly fluctuating red and blue signals behind certain strongly reflecting structures. In this series, we hypothesize that twinkling artifacts might appear in small-bowel bezoars, and we describe the presence of twinkling artifacts in 3 cases of small-bowel bezoars presenting as small-bowel obstruction.
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Nielsen KR, Ewertsen C, Hillingsø JG. [Gastric bezoar caused by barium sulphate]. Ugeskr Laeger 2012; 174:129-130. [PMID: 22248851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We present the first case of a gastric bezoar caused by barium sulphate acting as an intermittently occluding mass in a patient who had undergone small bowel follow-through on suspicion of small bowel obstruction (SBO) after total pancreatectomy. The patient underwent acute surgery but intermittent symptoms of SBO persisted. A barium bezoar was seen on plain abdominal film and afterwards diluted and fragmented gastroscopically. A barium bezoar giving rise to SBO is a possible complication to barium follow-through in patients with impaired gastric transit time.
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Gümüs M, Kapan M, Onder A, Tekbas G, Yagmur Y. An unusual cause of small bowel obstruction: dried apricots. J PAK MED ASSOC 2011; 61:1130-1131. [PMID: 22125996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Small bowel obstruction is rarely caused by bezoars. An important cause of phytobezoars are dried fruits. A 56 year old man presented to our department with symptoms of acute intestinal obstruction. Abdomen was distended and tender at the right and left lower quadrants. Bowel movements were decreased, and rectum was empty on digital examination. Upright plain films of the abdomen revealed multiple air-fluid levels and patient was immediately operated on. Due to the ischaemia of short small bowel segment, resection and end to end anastomosis were performed. After resection, bowel was opened and an apricot was found in the small bowel lumen. Although the dried apricot was small enough to pass through the pylorus spontaneously, it became swollen in fluid and started to obstruct the small bowel lumen especially in the terminal ileum. Obstruction by undigested food is rare and mostly seen in children, edentulous older people and patients with mental disorders. In conclusion, dried fruits, when swallowed without chewing, may cause intestinal obstruction.
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Márquez-Rojas J, Roldán-Baños S, López-Guerra D, Onieva-González FG, Jiménez-Redondo JL, Leal-Macho A. [Bezoar after ingestion of metallic foreign bodies]. CIR CIR 2011; 79:464-467. [PMID: 22385768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Ingestion of foreign bodies represents a common feature in psychiatric patients and prisoners. Bezoar is a conglomeration of partially or undigested foreign material in the gastrointestinal tract. These are classified into several types according to the materials which they are composed of, the least frequent being metals. There are few cases reported in the literature. CLINICAL CASE We report a case of a patient with a pathological history of mental disorder. The patient complained of abdominal pain 24 h prior, and there were no other symptoms. Physical examination revealed pain in the upper quadrant without peritoneal irritation. Laboratory tests were normal and plain x-ray of the abdomen showed several metallic foreign bodies, some sharp, >5 cm in length and with intestinal prolongation. Surgical intervention was performed several hours later: gastrotomy to remove the gastric bezoar that was composed of several screws, nails, scrap metal, lighters, clothespins, radio antennas and one coin. Four metallic foreign bodies were found in the small bowel after reviewing the abdominal cavity, so enterotomy was also performed to remove them. Postoperative course was uneventful. CONCLUSIONS Surgical treatment must be considered in cases of multiple, large, sharp objects or complications. An exhaustive study of the case is essential to avoid delay in treatment and potential complications.
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Aybar A, Safta AM. Endoscopic removal of a gastric trichobezoar in a pediatric patient. Gastrointest Endosc 2011; 74:435-7. [PMID: 21272870 DOI: 10.1016/j.gie.2010.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 11/11/2010] [Indexed: 12/11/2022]
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Ziadi T, En-nafaa I, Lamsiah T, Abilkacem EH, Hanine A, Hoummadi A. Une masse épigastrique. Rev Med Interne 2011; 32:445-6. [PMID: 20850914 DOI: 10.1016/j.revmed.2010.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 08/16/2010] [Indexed: 11/19/2022]
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Abstract
Bezoars are concretions of foreign matter in the gastrointestinal tract which may cause nonspecific symptoms, including epigastric discomfort, early satiety, and constipation, and rarely gastrointestinal obstruction. We report a case in which the migration of bezoars led to secondary gastrointestinal obstruction. With endoscopy manipulation and chemical dissolution, such as with Coca-Cola, to disintegrate the gastric bezoars, the possibility that fragmented residuals may coalesce in the small intestine causing ileus should be considered when a patient presents with abdominal obstruction symptoms after these procedures. In this condition, abdominal plain film X-ray and computer tomography play important roles in timely diagnosis.
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Freund Y, Boulanger X, Riou B. An unusual case of bowel obstruction: phytobezoar mimicking narcotic drug packs. Emerg Med J 2011; 28:86. [PMID: 20947919 DOI: 10.1136/emj.2009.075044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bhargava P, Phillips G. Giant gastric bezoar presenting as an acute abdominal emergency. Pediatr Radiol 2010; 40 Suppl 1:S99. [PMID: 20119831 DOI: 10.1007/s00247-009-1511-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 11/15/2009] [Accepted: 12/14/2009] [Indexed: 11/27/2022]
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Fetzner UK, Oana IC, Büschel P, Kasch R, Alakus H, Moenig SP, Herbold T, Stippel DL, Scheele J. Phytobezoar: impact of differential diagnosis and difficulties in technical diagnostics. Comment on: Park JW, Chae HD: phytobezoar of the stomach. Dig Surg 2009;26:451-452. Dig Surg 2010; 27:339. [PMID: 20689299 DOI: 10.1159/000308459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Fedotov IL, Gushchina LI, Fedotov OI. [Principles of diagnostics and treatment in bezoar of the stomach]. VESTNIK KHIRURGII IMENI I. I. GREKOVA 2010; 169:97-98. [PMID: 20804038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Hernández-Gea V, García-Alba C, Soriano G, Carlos Pernas J, Farré A. [Coexistencia del síndrome de la arteria mesentérica superior y fitobezoar]. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 32:132-4. [PMID: 19231695 DOI: 10.1016/j.gastrohep.2008.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Accepted: 09/03/2008] [Indexed: 01/01/2023]
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