[Small-bowel ileus caused by a gold filling]

A 68-years-old man was admitted to hospital with signs of intestinal obstruction. Computed tomography showed a foreign body, and the patient underwent laparotomy which revealed a gold filling in the jejunum. To our knowledge, this is the first documented case of a gold filling causing intestinal obstruction.

[Iron deficiency anaemia, pancreatitis and epigastric mass in a young female: a rare presentation of a large gastric trichobezoar]

We report the case of a 15-year old girl presenting with a gastric fullness sensation. The biological examination showed iron deficiency anaemia and elevation of the pancreatic enzymes. At endoscopy, a huge trichobezoar is found in the stomach. The endoscopic removal is impossible due to the compacity of the mass. Surgical resection is therefore performed. The postoperative course is uneventful and the biologic anomalies are rapidly corrected. A throughout anamnesis revealed a trichotillomania with trichophagia, this behavioural trouble found its origin in a familial conflict.

Obstructing small bowel bezoars due to an agar diet: diagnosis using double balloon enteroscopy

Primary small bowel bezoars are rare and may cause acute abdomen due to small bowel obstruction (SBO). A 70-year-old Japanese woman presented to the emergency room with abdominal pain, nausea and vomiting. The patient reported that she had eaten a large amount of highly-concentrated, agar dissolved in boiling water two days prior to presentation. Double balloon enteroscopy (DBE) revealed that white-colored, hard bezoars were clogged in the jejunum. At surgery, many bezoars were found impacted in the distal jejunum, and enterotomy was performed. The bezoars were elastic hard, crystallized objects. These bezoars were considered to have formed from highly-concentrated, dissolvable agar.

Duodenal date seed bezoar: a very unusual cause of partial gastric outlet obstruction

Bezoars are concretions of undigested or partially digested foreign material in the gastrointestinal or genitourinary tract of humans or animals. Originally described from Persia, they have been known to mankind for centuries. Bezoars are an uncommon cause of benign mechanical gastric outlet obstruction. A variety of materials have been found to form bezoars, such as hair, undigested food, persimmons, milk products, medicines, etc. Development of bezoars is usually associated with predisposing risk factors. We describe a very unusual case of duodenal date seed bezoar causing partial gastric outlet obstruction in a person with no known risk factors. To the best of our knowledge, duodenal bezoars formed by date seeds have not been reported previously in the English literature.

A barium chemobezoar in an infant

A case report is presented of an infant who developed a large barium concretion proximal to a jejunal anastomosis. A brief literature review outlines the issues involved in the indications for, and choice of, contrast material for use in the precise radiological diagnosis of upper intestinal obstruction in infants.

Small bowel obstructions secondary to bezoars

BACKGROUND

We aimed to present our experience on computed tomography (CT) findings of small bowel obstruction due to bezoar impaction.

METHODS

CT scans of seven patients (3 males, 4 females, age range; 30-93 years) who were diagnosed as small bowel obstruction due to bezoars were reviewed.

RESULTS

In each patient, an intraluminal mass with a mottled gas pattern on CT enabled specific preoperative diagnosis of bezoars, and postoperative changes such as anastomotic lines and afferent-efferent loops.

CONCLUSION

CT imaging is useful in making the diagnosis of bezoar associated with small bowel obstruction, and greatly helps assessing the detailed abdominal anatomy.

Rapunzel syndrome reviewed and redefined

Rapunzel syndrome is a rare presentation of a trichobezoar, with 24 cases having been reported in literature so far. This syndrome has been reported in 23 female and 1 male patient with a mean age of 10.8 years. The patients commonly present with abdominal pain, nausea, vomiting and signs of obstruction. The distal end of the bezoar may be in the jejunum, ileum or the colon. We evaluate the various cases reported and discuss the various modes of presentation of this uncommon syndrome, and also present a series of 3 cases, all females, aged 16, 18 and 21 years, and had a trichobezoar in the stomach with a tail extending into the ileum.

Laparoscopic removal of gastric bezoar

Many approaches have been proposed for the treatment of bezoars, such as gastroscopic fragmentation, nasogastric lavage or suction, and enzymatic therapy. Because gastroscopic removal has not always been successful, especially in large gastric bezoars, surgical removal by gastrotomy through abdominal incision has been performed. With the advent of laparoscopic surgery, it became possible to remove such lesions without large abdominal incisions. In this case, we present a 62-year-old male who had gastric phytobezoar that was successfully treated with a laparoscopic technique.

A case of pharmacobezoar in a patient with ileostomy

We report a case of a 59-year-old white male who presented with right-sided abdominal pain of 6 months duration. The patient had a total colectomy and Brooks continent ileostomy 20 years ago for severe ulcerative colitis. A CT scan of the abdomen and pelvis revealed large number of pills (pharmacobezoar) in the small bowel, just proximal to the ileostomy pouch. The patient underwent a laparotomy and enterotomy, which resulted in extraction of more than 50 pills from the small bowel. He had no symptoms during the subsequent follow up visits.

Closed perforation of the small bowel secondary to a phytobezoar: imaging findings

Small bowel perforation secondary to phytobezoars is a rare clinical entity, which is not well-documented in the radiological literature. Sonographic and computed tomography (CT) findings of a case of closed small bowel perforation secondary to phytobezoars in a patient with previous gastric surgery are presented. Both abdominal ultrasound and CT examinations revealed a collection containing air at the left lower quadrant as well as neighboring intraluminal masses suggestive of bezoars. We propose that appropriate CT examination is a very useful imaging modality for evaluating this kind of bowel perforation.

Bezoar-related pancreatitis in enterically drained pancreas transplant

Simultaneous kidney and pancreas transplantation is currently the treatment of choice for type 1 diabetes mellitus with end-stage renal disease. As a result of improvements in surgical techniques and the efficacy of immunosuppression, patient and graft survival rates have improved dramatically over the last two decades. Despite this, it remains a challenging surgical procedure with many potential complications and occasional controversies. Causes of pancreatitis after pancreas transplantation with enteric drainage are not well documented in the literature. We report a case of allograft pancreatitis from pancreatic duct outflow obstruction due to formation of a bezoar in a diverticulized transplant duodeno-jejunal anastomosis. To the best of our knowledge, this is the first case of allograft pancreatitis reported in the literature occurring from bezoar formation.

Duodenal obstruction secondary to date stone impaction

The use of non-invasive imaging techniques to rapidly establish diagnosis has always been an attempt in emergency situations. Recent significant advances in imaging technology have changed approach and algorithm of many emergencies. We present a case of swallowed date stone resulting in duodenal obstruction in a 10-year old child. Following the suspicion of a foreign body impaction which caused symptoms of acute intestinal obstruction, the case was diagnosed precisely by conventional sonography. This spared the patient the laparotomy scheduled initially. Instead, endoscopic removal of the date stone was accomplished successfully with smooth recovery.

Bezoar Formation Requiring Endoscopic Removal After Intentional Overdose of Extended-Release Nifedipine

A 61-year-old Caucasian woman was transported to the emergency department after intentionally ingesting several different prescription drugs. She had been found by her husband in an unconscious state with empty bottles of extended-release venlafaxine, extended-release nifedipine, sertraline, and atorvastatin. She was intubated in the emergency department and transferred to the intensive care unit. After 36 hours in the intensive care unit, she was stabilized and brought to a general medical ward. She later developed profound recurrent hypotension with systolic blood pressures ranging from 40-70 mm Hg and diastolic blood pressures of 0-40 mm Hg. She was readmitted to the intensive care unit, where a computed tomography scan revealed a mass in her stomach. A gastroenterology consultation was obtained, and an esophagogastroduodenoscopy (EGD) was performed, during which a large drug bezoar was discovered and removed. The drugs were identified as extended-release nifedipine with a few granules of extended-release venlafaxine. Unfortunately, the patient died 3 days after the EGD from multisystem organ failure related to the overdose. Clinicians who encounter drug overdoses should be aware of the possibility of drug bezoar formation and should consider endoscopic removal as a potential treatment option.

[Unusual postoperative fistula of the abdominal wall, caused by an ingested wooden spit perforating the intestine and lodging itself in the abdominal wall]

Abdominal fistula caused by an ingested wooden spit, which penetrated the intestinal wall and remained in the abdominal wall: a laparascopy was performed in a 41-year-old man suffering from acute appendicitis and an inflamed Meckel's diverticulum. After removal of the appendix and the diverticulum, a fistula developed in the excision channel of the left quadrant of the abdominal wall post-operatively. Despite repeated incision of the abscess in the course of 2 months, the fistula did not heal. Ultrasound examination of the abdominal wall was therefore performed. The postoperative status was without conspicuous findings. We could, however, detect a foreign body, a few centimetres long and 2-3 mm thick, displaying a smooth surface, deep down in the abdominal wall. A fistulography confirmed the diagnosis. After removal of the wooden spit, complete healing of the fistula in the abdominal wall was observed. Subsequently, the patient reported to have eaten a beef roulade, fixed with a wooden spit, 7 weeks before the abdominal operation.