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Gochilaidze G, Albakkour O, Shamieh N, Draouat A, Golde E, Budnik R, Schönberger J. [Intestinal colic after cabbage roll]. CHIRURGIE (HEIDELBERG, GERMANY) 2024:10.1007/s00104-024-02133-7. [PMID: 39141096 DOI: 10.1007/s00104-024-02133-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/02/2024] [Indexed: 08/15/2024]
Affiliation(s)
- Gia Gochilaidze
- Klinik für Orthopädie und Chirurgie, LUP-Klinikum am Crivitzer See, Amtstraße 1, 19089, Crivitz, Deutschland.
| | - O Albakkour
- Klinik für Orthopädie und Chirurgie, LUP-Klinikum am Crivitzer See, Amtstraße 1, 19089, Crivitz, Deutschland
| | - N Shamieh
- Klinik für Orthopädie und Chirurgie, LUP-Klinikum am Crivitzer See, Amtstraße 1, 19089, Crivitz, Deutschland
| | - A Draouat
- Klinik für Orthopädie und Chirurgie, LUP-Klinikum am Crivitzer See, Amtstraße 1, 19089, Crivitz, Deutschland
| | - E Golde
- Klinik für Orthopädie und Chirurgie, LUP-Klinikum am Crivitzer See, Amtstraße 1, 19089, Crivitz, Deutschland
| | - R Budnik
- Klinik für Orthopädie und Chirurgie, LUP-Klinikum am Crivitzer See, Amtstraße 1, 19089, Crivitz, Deutschland
| | - J Schönberger
- Klinik für Orthopädie und Chirurgie, LUP-Klinikum am Crivitzer See, Amtstraße 1, 19089, Crivitz, Deutschland
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2
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Belluzzi A, Sample JW, Marrero K, Tomey D, Puvvadi S, Sharma I, Ghanem OM. Rare Complications Following Laparoscopic Sleeve Gastrectomy. J Clin Med 2024; 13:4456. [PMID: 39124722 PMCID: PMC11313060 DOI: 10.3390/jcm13154456] [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: 07/08/2024] [Revised: 07/26/2024] [Accepted: 07/27/2024] [Indexed: 08/12/2024] Open
Abstract
Metabolic and bariatric surgery (MBS) is the most effective and durable therapeutic intervention for patients with obesity. In recent years, laparoscopic sleeve gastrectomy (SG) has become the most commonly performed primary MBS procedure owing to its technical feasibility and excellent short-term outcomes. Despite these favorable results and perceived advantages, SG is associated with several unique complications. Complications such as a postoperative leak or bleeding have been more commonly observed and reported than others, and their management approaches are well described. However, other complications following SG are far less familiar to surgeons, which may delay recognition and result in poor patient outcomes. Of these complications, we describe splenic injuries; esophageal perforation; staple line malformations; stapling of intraluminal devices; phytobezoar formation; gastro-colic, gastro-pleural and gastro-bronchial fistula; pancreatic leak; and portomesenteric venous thrombosis. It is paramount for surgeons to be aware of these underreported issues and have the resources to learn how to recognize and manage them when they arise. This review aims to describe rare (i.e., reported incidence <1%) and underdescribed complications after SG, focusing on causes, clinical presentation, prevention strategies, and management.
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Affiliation(s)
- Amanda Belluzzi
- Department of Surgery, Mayo Clinic, Rochester, MN 55095, USA; (A.B.); (J.W.S.)
- Department of Surgery, Rovigo Hospital, 45100 Rovigo, Italy
| | - Jack W. Sample
- Department of Surgery, Mayo Clinic, Rochester, MN 55095, USA; (A.B.); (J.W.S.)
| | - Katie Marrero
- Carle Foundation Hospital General Surgery Residency, Champaign, IL 61801, USA
| | - Daniel Tomey
- Department of General Surgery, Houston Methodist Hospital, Houston, TX 77030, USA;
| | - Suraj Puvvadi
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA
| | - Ishna Sharma
- St. Peter’s Health Partners Bariatric and Metabolic Care, Albany, NY 12208, USA;
| | - Omar M. Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN 55095, USA; (A.B.); (J.W.S.)
- Division of Metabolic and Abdominal Wall Reconstructive Surgery, Mayo Clinic, Rochester, MN 55095, USA
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3
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Shu J, Zhang H. Tennis ball cord combined with endoscopy for giant gastric phytobezoar: A case report. World J Clin Cases 2024; 12:3603-3608. [PMID: 38983432 PMCID: PMC11229917 DOI: 10.12998/wjcc.v12.i18.3603] [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: 03/07/2024] [Revised: 04/22/2024] [Accepted: 05/15/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Due to the specificity of Chinese food types, gastric phytobezoars are relatively common in China. Most gastric phytobezoars can be removed by chemical enzyme lysis and endoscopic fragmentation, but the treatment for large phytobezoars is limited, and surgical procedures are often required for this difficult problem. CASE SUMMARY For giant gastric phytobezoars that cannot be dissolved and fragmented by conventional treatment, we have invented a new lithotripsy technique (tennis ball cord combined with endoscopy) for these phytobezoars. This non-interventional treatment was successful in a patient whose abdominal pain was immediately relieved, and the gastroscope-induced ulcer healed well 3 d after lithotripsy. The patient was followed-up for 8 wk postoperatively and showed no discomfort such as abdominal pain. CONCLUSION The combination of tennis ball cord and endoscopy for the treatment of giant gastric phytobezoars is feasible and showed high safety and effectiveness, and can be widely applied in hospitals of all sizes.
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Affiliation(s)
- Juan Shu
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
| | - Heng Zhang
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
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4
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Nandipati KC, Bremer KC. Bariatric Surgery Emergencies in Acute Care Surgery. Surg Clin North Am 2023; 103:1113-1131. [PMID: 37838459 DOI: 10.1016/j.suc.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Patients who have undergone bariatric surgery present unique challenges in the acute care surgery setting. This review includes the presentation, workup, and management of most common bariatric surgery emergencies encountered by acute care surgery.
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Affiliation(s)
- Kalyana C Nandipati
- Division of Clinical Research, Department of Surgery, Creighton University School of Medicine, Minimally Invasive Surgery, Creighton University Education Building, 7710 Mercy Road, Suite 501, Omaha, NE 68124-2368, USA.
| | - Kristin C Bremer
- Department of Surgery, Creighton University School of Medicine, Creighton University Education Building, 7710 Mercy Road, Suite 501, Omaha, NE 68124-2368, USA
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5
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Khalaj A, Barzin M, Ebadinejad A, Mahdavi M, Ebrahimi N, Valizadeh M, Hosseinpanah F. Revisional Bariatric Surgery due to Complications: Indications and Outcomes. Obes Surg 2023; 33:3463-3471. [PMID: 37770774 DOI: 10.1007/s11695-023-06832-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 09/06/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND The increasing prevalence of bariatric procedures has led to a surge in revisional surgeries. Failure of bariatric surgery can be attributed to inadequate weight loss or complications necessitating revisional surgery. In this study, we investigated the indications and outcomes of revisional surgery due to complications following primary bariatric surgery. MATERIALS AND METHODS A retrospective study was conducted using data from the Tehran Obesity Treatment Study, which included patients who underwent revisional bariatric surgery between March 2013 and September 2021 due to complications following primary bariatric surgery. RESULTS Of the 5382 patients who underwent primary bariatric surgery (sleeve gastrectomy, one-anastomosis gastric bypass, and Roux-en-Y gastric bypass), 203 (3.70%) required revisional surgery, with 37 cases performed due to surgical complications. The indications of revisional operations were gastroesophageal reflux disease (GERD) (n=17, 45.9%), protein-calorie malnutrition (PCM) (n=14, 37.8%), unexplained abdominal pain (n=5, 13.5%), and phytobezoar (n=1, 0.03%). In the postoperative follow-up, most patients exhibited improvement in signs and symptoms related to underlying causes. However, eight patients experienced early or late complications of grade III or higher according to the Clavien-Dindo classification, with one death resulting from liver failure. CONCLUSION Revisional bariatric surgery may effectively address complications from primary bariatric surgery, with the majority of patients experiencing improvements in symptoms. While the overall incidence of revisional surgery due to complications is relatively low, our findings suggest that GERD and PCM are the most common indications for revisional surgery.
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Affiliation(s)
- Alireza Khalaj
- Tehran Obesity Treatment Center, Department of Surgery, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-476, Tehran, Iran
| | - Amir Ebadinejad
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-476, Tehran, Iran.
| | - Maryam Mahdavi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-476, Tehran, Iran
| | - Navid Ebrahimi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-476, Tehran, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-476, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-476, Tehran, Iran.
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Abreu da Silva A, Ricardo J, Ferreira A, Sousa D, Martins JA. Small Bowel Obstruction by a Phytobezoar in a Patient With Previous Antrectomy and Billroth II Reconstruction. Cureus 2023; 15:e45849. [PMID: 37881390 PMCID: PMC10594844 DOI: 10.7759/cureus.45849] [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: 09/22/2023] [Indexed: 10/27/2023] Open
Abstract
A phytobezoar is a conglomerate of improperly digested fruit and vegetable debris, and its development is associated, amongst other factors, with previous gastric surgery. Most phytobezoars remain asymptomatic and are incidentally found during imaging or interventional procedures. However, in some patients, they can cause small bowel obstruction, which can subsequently lead to severe complications. Although the clinical findings are similar to other causes of intestinal obstruction, there are some particular diagnostic and treatment features more specific to phytobezoars. We present a case of an 85-year-old man with a history of previous antrectomy and Billroth II reconstruction who came to the emergency department with bilateral aspiration pneumonia and intestinal obstruction due to a bezoar. The CT scan showed bilateral inferior lobe pulmonary consolidation, as well as a marked dilation of the small bowel with gas-fluid levels and a transition to normal caliber in the terminal ileum, where an oval mottled-appearing mass suggesting a bezoar was present. An urgent laparotomy confirmed the diagnosis, and an enterotomy with removal of the bezoar was performed. Phytobezoars must be considered as a cause of intestinal obstruction, particularly when patients have a history of previous gastric surgery. Its radiological findings, particularly in CT scans, are specific and should be appreciated to establish the diagnosis promptly. The treatment of small bowel obstruction due to a phytobezoar requires surgery most of the time, and the surgeon must bear in mind the need to look for the existence of other bezoars in the gastrointestinal tract to prevent reoccurrence.
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Affiliation(s)
| | - Jéssica Ricardo
- General Surgery, Hospital do Litoral Alentejano, Santiago do Cacém, PRT
| | - Andreia Ferreira
- General Surgery, Hospital do Litoral Alentejano, Santiago do Cacém, PRT
| | - Diogo Sousa
- General Surgery, Hospital do Litoral Alentejano, Santiago do Cacém, PRT
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Kosmidis CS, Mystakidou CM, Varsamis N, Koulouris C, Sevva C, Papadopoulou K, Michael C, Katsios NI, Theodorou V, Miltiadous P, Papadopoulos K, Vlassopoulos K, Zarampouka K, Mantalovas S. Phytobezoar-Induced Mechanical Ileus and Incipient Intussusception: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1227. [PMID: 37512039 PMCID: PMC10383327 DOI: 10.3390/medicina59071227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023]
Abstract
Phytobezoars constitute conglomerates of indigested plant fibers and are a rare cause of acute mechanical ileus. They exhibit an increased prevalence in the elderly population and people with specific predisposing conditions. Radiological imaging can often set a definitive diagnosis and dictate the optimal therapeutic approach, combined with the patient's clinical status. An 81-year-old male presented with deteriorating clinical symptoms of intestinal obstruction, and an exploratory laparotomy was performed following inconclusive radiological findings; multiple phytobezoars and incipient intussusception were revealed intraoperatively. A patient's medical history can often raise clinical suspicion of phytobezoars. However, a careful etiological investigation is imperative in all cases of mechanical ileus in advanced ages; early detection and dissolution of phytobezoars, when applicable, can reduce the need for surgical interventions.
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Affiliation(s)
- Christoforos S Kosmidis
- European Interbalkan Medical Center, 10 Asklipiou Street, 55535 Pylaia, Greece
- 3rd Surgical Department, University General Hospital of Thessaloniki "AHEPA", School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
| | - Chrysi Maria Mystakidou
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Nikolaos Varsamis
- European Interbalkan Medical Center, 10 Asklipiou Street, 55535 Pylaia, Greece
| | - Charilaos Koulouris
- European Interbalkan Medical Center, 10 Asklipiou Street, 55535 Pylaia, Greece
- 3rd Surgical Department, University General Hospital of Thessaloniki "AHEPA", School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
| | - Christina Sevva
- 3rd Surgical Department, University General Hospital of Thessaloniki "AHEPA", School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
| | - Konstantina Papadopoulou
- 1st Department of Internal Medicine, G. Papanikolaou General Hospital of Thessaloniki, 57010 Thessaloniki, Greece
| | - Christina Michael
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Nikolaos Iason Katsios
- Medical School, Faculty of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Vasiliki Theodorou
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Petrina Miltiadous
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Konstantinos Papadopoulos
- 3rd Surgical Department, University General Hospital of Thessaloniki "AHEPA", School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
| | - Konstantinos Vlassopoulos
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Katerina Zarampouka
- Pathology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
| | - Stylianos Mantalovas
- 3rd Surgical Department, University General Hospital of Thessaloniki "AHEPA", School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
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8
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De Simone B, Chouillard E, Ramos AC, Donatelli G, Pintar T, Gupta R, Renzi F, Mahawar K, Madhok B, Maccatrozzo S, Abu-Zidan FM, E Moore E, Weber DG, Coccolini F, Di Saverio S, Kirkpatrick A, Shelat VG, Amico F, Pikoulis E, Ceresoli M, Galante JM, Wani I, De' Angelis N, Hecker A, Sganga G, Tan E, Balogh ZJ, Bala M, Coimbra R, Damaskos D, Ansaloni L, Sartelli M, Pararas N, Kluger Y, Chahine E, Agnoletti V, Fraga G, Biffl WL, Catena F. Operative management of acute abdomen after bariatric surgery in the emergency setting: the OBA guidelines. World J Emerg Surg 2022; 17:51. [PMID: 36167572 PMCID: PMC9516804 DOI: 10.1186/s13017-022-00452-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/16/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Patients presenting with acute abdominal pain that occurs after months or years following bariatric surgery may present for assessment and management in the local emergency units. Due to the large variety of surgical bariatric techniques, emergency surgeons have to be aware of the main functional outcomes and long-term surgical complications following the most performed bariatric surgical procedures. The purpose of these evidence-based guidelines is to present a consensus position from members of the WSES in collaboration with IFSO bariatric experienced surgeons, on the management of acute abdomen after bariatric surgery focusing on long-term complications in patients who have undergone laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. METHOD A working group of experienced general, acute care, and bariatric surgeons was created to carry out a systematic review of the literature following the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) and to answer the PICO questions formulated after the Operative management in bariatric acute abdomen survey. The literature search was limited to late/long-term complications following laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. CONCLUSIONS The acute abdomen after bariatric surgery is a common cause of admission in emergency departments. Knowledge of the most common late/long-term complications (> 4 weeks after surgical procedure) following sleeve gastrectomy and Roux-en-Y gastric bypass and their anatomy leads to a focused management in the emergency setting with good outcomes and decreased morbidity and mortality rates. A close collaboration between emergency surgeons, radiologists, endoscopists, and anesthesiologists is mandatory in the management of this group of patients in the emergency setting.
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Affiliation(s)
- Belinda De Simone
- Department of Emergency, Digestive and Metabolic Minimally Invasive Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy-Ile de France, France.
| | - Elie Chouillard
- Department of Emergency, Digestive and Metabolic Minimally Invasive Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy-Ile de France, France
| | - Almino C Ramos
- GastroObesoCenter Institute for Metabolic Optimization, Sao Paulo, Brazil
| | - Gianfranco Donatelli
- Interventional Endoscopy and Endoscopic Surgery, Hôpital Privé Des Peupliers, Paris, France
| | - Tadeja Pintar
- Department of Abdominal Surgery, Ljubljana University Medical Centre, Ljubljana, Slovenia
| | - Rahul Gupta
- Division of Minimally Invasive Surgery and Bariatrics, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Federica Renzi
- General Surgery and Trauma Team, ASST Niguarda, Piazza Ospedale Maggiore 3, 20162, Milano, Milan, Italy
| | - Kamal Mahawar
- South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Brijesh Madhok
- East Midlands Bariatric and Metabolic Institute, University Hospitals of Derby and Burton NHS Trust, Derby, UK
| | - Stefano Maccatrozzo
- Department of Bariatric Surgery, Istituto Di Cura Beato Matteo, Vigevano, Italy
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Ernest E Moore
- Denver Health System - Denver Health Medical Center, Denver, USA
| | - Dieter G Weber
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Federico Coccolini
- Department of Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Salomone Di Saverio
- Department of Surgery, Madonna Del Soccorso Hospital, San Benedetto del Tronto, Italy
| | - Andrew Kirkpatrick
- Department of General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB, Canada
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Francesco Amico
- Department of Surgery, John Hunter Hospital and The University of Newcastle, Newcastle, MSW, Australia
| | - Emmanouil Pikoulis
- 3Rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Marco Ceresoli
- General Surgery, Monza University Hospital, Monza, Italy
| | - Joseph M Galante
- University of California, Davis 2315 Stockton Blvd., Sacramento, CA, 95817, USA
| | - Imtiaz Wani
- Government Gousia Hospital, Srinagar, Kashmir, India
| | - Nicola De' Angelis
- Service de Chirurgie Digestive Et Hépato-Bilio-Pancréatique - DMU CARE, Hôpital Henri Mondor, Paris, France
| | - Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Gabriele Sganga
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Edward Tan
- Department of Emergency Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Miklosh Bala
- Trauma and Acute Care Surgery Unit, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Raul Coimbra
- Riverside University Health System Medical Center, Loma Linda University School of Medicine, Riverside, CA, USA
| | - Dimitrios Damaskos
- General and Emergency Surgery, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
| | - Luca Ansaloni
- Department of Surgery, Pavia University Hospital, Pavia, Italy
| | - Massimo Sartelli
- Department of General Surgery, Macerata Hospital, Macerata, Italy
| | - Nikolaos Pararas
- 3Rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Elias Chahine
- Department of Emergency, Digestive and Metabolic Minimally Invasive Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy-Ile de France, France
| | - Vanni Agnoletti
- Department of Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | - Gustavo Fraga
- School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP, Brazil
| | - Walter L Biffl
- Department of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, San Diego, CA, USA
| | - Fausto Catena
- Department of Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
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Powell CR, Magee JS, Papadopoulos IB. Diospyrobezoar Formation in Patient With Sleeve Gastrectomy. Cureus 2022; 14:e27561. [PMID: 36059363 PMCID: PMC9428366 DOI: 10.7759/cureus.27561] [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: 08/01/2022] [Indexed: 11/11/2022] Open
Abstract
The ingestion of Asian persimmons, Diospyros kaki, is a known cause of gastric bezoars. Patients with a history of gastric operations are at high risk for formation. Different forms of bariatric surgery have been implicated, but literature for bezoar following a sleeve gastrectomy is scarce. This case report describes the pathogenesis, clinical course, and definitive management of gastric diospyrobezoar following a sleeve gastrectomy. With the rising incidence of bariatric procedures being performed, providers should include bezoar in the differential diagnosis in patients with suspected gastric outlet obstruction and should be aware of treatment options for this patient population.
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10
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Palma R, Ruggiero L, Santonicola A, Iovino P, Angrisani L. A Conservative Management of Gastric Bezoar in a Novel Bariatric Procedure: Nissen-Sleeve Gastrectomy. Obes Surg 2022; 32:944-947. [PMID: 35079950 PMCID: PMC8789371 DOI: 10.1007/s11695-021-05830-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Rossella Palma
- Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Luigi Ruggiero
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana, " University of Salerno, Baronissi, (SA), Italy
| | - Antonella Santonicola
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana, " University of Salerno, Baronissi, (SA), Italy
| | - Paola Iovino
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana, " University of Salerno, Baronissi, (SA), Italy
| | - Luigi Angrisani
- Department of Public Health, Federico II" University of Naples, Naples, Italy.
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11
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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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12
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Sherf-Dagan S, Sinai T, Goldenshluger A, Globus I, Kessler Y, Schweiger C, Ben-Porat T. Nutritional Assessment and Preparation for Adult Bariatric Surgery Candidates: Clinical Practice. Adv Nutr 2021; 12:1020-1031. [PMID: 33040143 PMCID: PMC8262552 DOI: 10.1093/advances/nmaa121] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/25/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022] Open
Abstract
Bariatric surgery (BS) has proven to be highly efficacious in the treatment of obesity and its comorbidities. However, careful patient selection is critical for its success. Thus, patients should undergo medical, behavioral, and nutritional assessment by a multidisciplinary team. From the nutritional point of view, BS candidates should undergo nutritional assessment, preparation, and education by a registered dietitian in the preoperative period. Currently, detailed specified and comprehensive information on these topics is lacking. The present narrative review aimed to summarize the available literature concerning both the preoperative nutritional assessment components and the preoperative nutritional preparation and education components of patients planning to undergo BS. Current literature indicates that proper management before BS should include a comprehensive nutritional assessment, in which it is advisable to perform a clinical interview to assess patients' medical background, weight management history, eating patterns and pathologies, oral health, physical activity habits, nutritional status, supplementation usage, BS knowledge, surgery expectations and anthropometric measurements. Nutritional preparation and educational strategies should include an individualized preoperative weight-loss nutrition program, improvement of glycemic control, micronutrients deficiencies correction, eating and lifestyle habits adaptation, physical activity initiation, and strengthening knowledge on obesity and BS. At this stage, more well-designed intervention and long-term cohort studies are needed in order to formulate uniform evidence-based nutritional guidelines for patients who plan to undergo BS, including populations at higher nutritional risk. Moreover, postoperative outcomes of presurgical nutritional intervention programs should be studied.
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Affiliation(s)
- Shiri Sherf-Dagan
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel
- Department of Nutrition, Assuta Medical Center, Tel Aviv, Israel
| | - Tali Sinai
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
- School of Nutritional Sciences, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Ariela Goldenshluger
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, and Sylvan Adams Sports Institute, Tel-Aviv University, Tel Aviv, Israel
| | | | - Yafit Kessler
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel
- Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel
| | - Chaya Schweiger
- Nutrition Service, Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel
| | - Tair Ben-Porat
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Ein-Kerem Campus, Jerusalem, Israel
- Department of Human Metabolism and Nutrition, Braun School of Public Health, Hebrew University, Jerusalem, Israel
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13
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Aryannezhad S, Sadeghian Y, Shapoori P, Valizadeh M, Barzin M. A rare case report of late-onset phytobezoar formation following laparoscopic sleeve gastrectomy: delayed redo bariatric surgery. BMC Surg 2021; 21:254. [PMID: 34022864 PMCID: PMC8140555 DOI: 10.1186/s12893-021-01254-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/17/2021] [Indexed: 02/08/2023] Open
Abstract
Background Phytobezoar formation is a complication of bariatric surgery and mostly occurs after laparoscopic Roux-en-Y gastric bypass (LRYGB) operations. Here, we present an extremely rare case of late phytobezoar formation following laparoscopic sleeve gastrectomy (LSG). Case presentation
A 52-year-old woman with a body mass index (BMI) of 40.7 kg/m2 underwent LSG. Following persistent symptoms of nausea, vomiting, early satiety, and tremendous weight loss, endoscopy was performed, and gastric phytobezoar was detected at one-year post-operation. After endoscopic fragmentation, phytobezoar was removed by snare, and the patient later underwent redo bariatric surgery (conversion of LSG to LRYGB). Conclusions With an increase in the number of LSG procedures performed globally, and the late-onset nature of phytobezoar formation, more cases of this complication are expected to be detected in future. Long-term postoperative follow-up alongside applying surgical methods to avoid gastric stenosis are needed to reduce the chance of phytobezoar formation in patients undergoing LSG.
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Affiliation(s)
- Shayan Aryannezhad
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yasaman Sadeghian
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Shapoori
- Department of Surgery, Faculty of Medicine, Tehran Obesity Treatment Center, Shahed University, Tehran, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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14
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Zwicky S, Inauen W, Pfefferkorn U. Case Report: Phytobezoar Causing Gastric Outlet Obstruction as a Late Complication After Biliopancreatic Diversion with Duodenal Switch. Obes Surg 2021; 30:3233-3235. [PMID: 32232642 DOI: 10.1007/s11695-020-04531-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Case report of a phytobezoar causing gastric outlet obstruction as a late complication after biliopancreatic diversion with duodenal switch, review of the literature and discussion of bezoars as a differential diagnosis in patients after bariatric surgery presenting with signs of intestinal obstruction.
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Affiliation(s)
- Simone Zwicky
- Department of Surgery, Bürgerspital Solothurn, Schöngrünstrasse 38, CH-4500, Solothurn, Switzerland
| | - Werner Inauen
- Department of Gastroenterology, Bürgerspital Solothurn, Schöngrünstrasse 38, CH-4500, Solothurn, Switzerland
| | - Urs Pfefferkorn
- Department of Surgery, Kantonsspital Olten, Baslerstrasse 150, CH-4600, Olten, Switzerland.
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15
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Geist ACB, Mottin CC, Dillenburg CF, Ramos RJ, Alves LB, Mulazzani CM, Hinrichsen LB, Padoin AV. Intestinal obstruction following gastric bypass. Obes Res Clin Pract 2021; 15:291-292. [PMID: 33839063 DOI: 10.1016/j.orcp.2021.04.001] [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] [Received: 03/30/2021] [Accepted: 04/02/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To draw the attention of the medical community to a differential diagnosis of intestinal obstruction due to bezoar in the late postoperative period of gastric bypass that requires diagnosis and emergency management. METHODS We report 8 cases of patients with intestinal obstruction due to bezoar in the late postoperative period of gastric bypass who required surgical intervention. CONCLUSION Intestinal obstruction due to fruit pomace is a late complication that may require urgent surgical intervention and should be considered in the differential diagnosis.
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Affiliation(s)
- Ana Carolina Brochado Geist
- Serviço de Atendimento ao paciente Obeso metabólico (SAO), Av. Dr Maurício Cardoso 931 sala 12, 93510-335, Novo Hamburgo, RS, Brazil; Graduate Program in Medicine and Health Sciences, PUCRS, Porto Alegre, RS, Brazil
| | - Cláudio Corá Mottin
- Center for Obesity and Metabolic Syndrome (COM), Hospital São Lucas, Av. Ipiranga, 6690 conjunto 801, 90619-900, Porto Alegre, RS, Brazil; Graduate Program in Medicine and Health Sciences, PUCRS, Porto Alegre, RS, Brazil; PUCRS, School of Medicine, Porto Alegre, RS, Brazil
| | - Carlos Frota Dillenburg
- Serviço de Atendimento ao paciente Obeso metabólico (SAO), Av. Dr Maurício Cardoso 931 sala 12, 93510-335, Novo Hamburgo, RS, Brazil
| | - Rafael Jacques Ramos
- Center for Obesity and Metabolic Syndrome (COM), Hospital São Lucas, Av. Ipiranga, 6690 conjunto 801, 90619-900, Porto Alegre, RS, Brazil; Graduate Program in Medicine and Health Sciences, PUCRS, Porto Alegre, RS, Brazil
| | - Leticia Biscaino Alves
- Center for Obesity and Metabolic Syndrome (COM), Hospital São Lucas, Av. Ipiranga, 6690 conjunto 801, 90619-900, Porto Alegre, RS, Brazil; Graduate Program in Medicine and Health Sciences, PUCRS, Porto Alegre, RS, Brazil
| | | | | | - Alexandre Vontobel Padoin
- Center for Obesity and Metabolic Syndrome (COM), Hospital São Lucas, Av. Ipiranga, 6690 conjunto 801, 90619-900, Porto Alegre, RS, Brazil; Graduate Program in Medicine and Health Sciences, PUCRS, Porto Alegre, RS, Brazil; PUCRS, School of Medicine, Porto Alegre, RS, Brazil.
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16
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Oved I, Endevelt R, Mardy-Tilbor L, Raziel A, Sherf-Dagan S. Health Status, Eating, and Lifestyle Habits in the Long Term Following Sleeve Gastrectomy. Obes Surg 2021; 31:2979-2987. [PMID: 33829384 DOI: 10.1007/s11695-021-05336-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/27/2021] [Accepted: 03/04/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Sleeve gastrectomy (SG) is an established bariatric procedure. However, long-term data on eating and lifestyle behaviors and their effect on weight outcomes are scarce. Therefore, this study aimed to examine these long-term behaviors and their associations to weight outcomes following SG. METHODS A long-term follow-up study (>5 years post-surgery) of 266 adult patients admitted to a primary SG surgery during 2008-2012 and who participated in a pre-surgery study was conducted. Data on pre-surgery demographics, anthropometrics, and medical status were obtained from the patients' medical records. Data on long-term health status, anthropometrics, lifestyle and eating habits, eating pathologies, follow-up regime, and satisfaction from the surgery were collected by an interview phone calls according to a structured questionnaire. RESULTS Data of 169 patients were available before and 7.8±1.0 years post-SG. Their baseline mean age was 41.8±11.3 years, and 71.6% of them were females. The mean post-surgery excess weight loss (EWL) was 53.2±31.2%, and 54.2% had EWL of ≥50%. Eating 3-6 meals per day, not having the urge to eat after dinner, separating liquids from solids, avoiding carbonated beverages, and performing physical activity were related to better weight-loss outcomes (P≤0.026). However, frequent need for eating sweets, binge eating, and feeling guilty or sad after eating were related to worse weight-loss outcomes (P≤0.010). Furthermore, only a minority reported taking a multivitamin and participating in follow-up meetings after more than 1 year since the surgery (≤21.3%). CONCLUSIONS In the long term following SG, approximately half achieved EWL of ≥50%, and physical activity, certain eating patterns, and eating pathologies were related to weight outcomes.
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Affiliation(s)
- Irit Oved
- School of Public Health, University of Haifa, Haifa, Israel
| | - Ronit Endevelt
- School of Public Health, University of Haifa, Haifa, Israel.,Nutrition Division, Ministry of Health, Jerusalem, Israel
| | | | - Asnat Raziel
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel
| | - Shiri Sherf-Dagan
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ramat HaGolan St 65, 40700, Ariel, Israel. .,Department of Nutrition, Assuta Medical Center, Tel-Aviv, Israel.
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17
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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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18
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Nie F, Han X, Huang X, Wang H, Wang Y, Zhong Y. Oesophageal mucosal tears caused by suboptimal nasogastric tube insertion: a case study. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:1308-1310. [PMID: 33325297 DOI: 10.12968/bjon.2020.29.22.1308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Oesophageal bezoars are one of the many causes of nasogastric tube obstruction; however, they are extremely rare and, therefore, not often considered to be the cause of a blockage. A bezoar is a solid mass of indigestible material that accumulates in the digestive tract. After a blockage is identified, the nasogastric tube is usually removed and another one inserted. However, this can be dangerous and can easily cause tearing of the oesophageal mucosa, bleeding, and other serious complications. In this article, the authors present a case of nasogastric tube obstruction caused by oesophageal bezoars. After the nasogastric tube was replaced, the patient experienced two tears of the oesophageal mucosa. This article highlights the importance of the introduction of a procedure for nurses to follow in cases of nasogastric tube obstruction, bearing in mind the possibility of the presence of oesophageal bezoars. If necessary, a gastroscope should be used to ensure safe insertion of the nasogastric tube and prevent oesophageal mucosal tears.
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Affiliation(s)
- Fali Nie
- Specialist Nurse, Emergency and Critical Department, Shenzhen Hospital of Southern Medical University, Shenzhen City, China
| | - Xiaoling Han
- Nurse Manager, Nursing Department, Zhuhai People's Hospital (Zhuhai Hospital affiliated with Jinan University), Zhuhai, China
| | - Xuanjie Huang
- Specialist Nurse, Emergency Department, The seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen City, China
| | - Huiying Wang
- Senior Nurse, Gynecology Ward, Shenzhen Hospital of Southern Medical University, Shenzhen City, China
| | - Yanyan Wang
- Senior Nurse, Emergency and Critical Department, Shenzhen Hospital of Southern Medical University, Shenzhen City, China
| | - Yanhui Zhong
- Senior Nurse, Emergency and Critical Department, Shenzhen Hospital of Southern Medical University, Shenzhen City, China
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19
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Kravitz SA, Song KH, Cioffi JH, Vega Colon KM, Lu MA. A Bariatric Curveball: A Rare Case of Recurrent Lactobezoars after Roux-en-Y Gastric Bypass Surgery. Mil Med 2020; 185:e1294-e1297. [PMID: 32804234 DOI: 10.1093/milmed/usz367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/06/2019] [Accepted: 09/06/2019] [Indexed: 11/13/2022] Open
Abstract
Bariatric surgery is a major risk factor for bezoar formation secondary to decreased gastric motility, gastric acidity, and pyloric function.1 This case is about a 49-year-old female veteran, 3 weeks status-post Roux-en-Y gastric bypass surgery, who presented with acute abdominal pain and oral intolerance. After being diagnosed with a bezoar and esophagogastroduodenoscopic removal, the patient had immediate relief of symptoms. Unfortunately, over the course of 4 months, this patient experienced three recurrent episodes of bezoar formation (with a possible fourth episode that could not be confirmed secondary to resolution of symptoms after administration of oral contrast load). Based on her dietary history and gross appearance of the bezoar, the patient was determined to have developed recurrent lactobezoars. Lactobezoars are composed of milk and mucous proteins and are commonly found in neonates with immature gastrointestinal tracts.7 This unusual complication demonstrates how current dietary recommendations encouraging dairy consumption to meet daily protein requirements may have increased this patient's risk for lactobezoar formation. This case illustrates the importance of balancing the risks and benefits of macronutrient requirements after bariatric surgery with postsurgical bezoar complications.
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Affiliation(s)
- Shena A Kravitz
- Felix Edward Hébert School of Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Kaoru H Song
- Department of Family Medicine, Tripler Army Medical Center, Family Medicine Residency, 1 Jarrett White Road, Medical Center, HI 96859
| | - Joseph H Cioffi
- Internal Medicine Residency, The George Washington University Hospital, 900 23rd St NW, Washington, DC 20037
| | - Karla M Vega Colon
- Department of Family Medicine, Tripler Army Medical Center, Family Medicine Residency, 1 Jarrett White Road, Medical Center, HI 96859
| | - Myro A Lu
- Department of Family Medicine, Tripler Army Medical Center, Family Medicine Residency, 1 Jarrett White Road, Medical Center, HI 96859
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20
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Martines G, Musa N, Aquilino F, Picciariello A, Altomare DF. Sleeve Gastrectomy Combined with Nissen Fundoplication as a Single Surgical Procedure, Is It Really Safe? A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e923543. [PMID: 32572016 PMCID: PMC7327731 DOI: 10.12659/ajcr.923543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Patient: Male, 40-year-old Final Diagnosis: Gastric perforation Symptoms: Abdominal pain Medication:— Clinical Procedure: Sleeve gastrectomy Nissen fundoplication Specialty: Surgery
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Affiliation(s)
- Gennaro Martines
- Department of General Surgery, "M. Rubino" University Hospital Polyclinic of Bari, Bari, Italy
| | - Nicola Musa
- Department of General Surgery, "M. Rubino" University Hospital Polyclinic of Bari, Bari, Italy
| | - Fabrizio Aquilino
- Department of General Surgery, "M. Rubino" University Hospital Polyclinic of Bari, Bari, Italy
| | - Arcangelo Picciariello
- Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
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21
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Wong WJ, Chua TC. Case of proximal small bowel obstruction: is it the motility or the chewing? ANZ J Surg 2020; 90:E223-E224. [PMID: 32506633 DOI: 10.1111/ans.16022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/13/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Wen Jye Wong
- Department of Surgery, Redland Hospital, Redland City, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Terence C Chua
- Department of Surgery, Redland Hospital, Redland City, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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22
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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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23
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Chang PC, Liu YW, Chen KH. Acute pouch outlet obstruction due to lactobezoar after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2019; 16:352-353. [PMID: 31862173 DOI: 10.1016/j.soard.2019.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 11/04/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Po-Chih Chang
- Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan; Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan; Weight Management Center, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan; Translational Research Center, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Yu-Wei Liu
- Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan; Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Kai-Hua Chen
- Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan.
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24
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Lin L, Wang C, Wu J, Liu K, Liu H, Wei N, Lin W, Jiang G, Tai W, Su H. Gastric phytobezoars: the therapeutic experience of 63 patients in Northern China. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 112:12-15. [PMID: 31599640 DOI: 10.17235/reed.2019.6400/2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Sixty-three patients with gastric phytobezoars were reviewed. METHODS forty-eight (76.2%) patients received endoscopic combined with chemical therapies and 15 (23.8%) received only chemical therapy initially. Fifty-one (81.0%) patients achieved complete removal (only chemical therapy 14/15), while 12 (19.0%) received further endoscopic therapies. RESULTS finally, 62 (98.4%) patients achieved a complete removal. Considering only patients with combined treatment as a first approach, treatment success was associated with a softer phytobezoar consistency (p = 0.023). CONCLUSION in conclusion, most patients achieve a favorable outcome. Chemical therapy is useful in selected cases. Repeated endoscopic therapies may be needed in order to completely remove phytobezoars with a hard consistency.
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Affiliation(s)
- Lin Lin
- Gastroenterology, Beijing Shijitan Hospital. Capital Medical University, China
| | - Canghai Wang
- Gastroenterology, Beijing Shijitan Hospital. Capital Medical University
| | - Jing Wu
- Gastroenterology, Beijing Shijitan Hospital. Capital Medical University
| | - Kuiliang Liu
- Gastroenterology, Beijing Shijitan Hospital. Capital Medical University
| | - Hong Liu
- Gastroenterology, Beijing Shijitan Hospital. Capital Medical University
| | - Nan Wei
- Gastroenterology, Beijing Shijitan Hospital. Capital Medical University
| | - Wu Lin
- Gastroenterology, Beijing Shijitan Hospital. Capital Medical University
| | - Guojun Jiang
- Beijing Shijitan Hospital, Capital Medical University
| | - Weiping Tai
- Gasstroenterology, Beijing Shijitan Hospital, Capital Medical University
| | - Hui Su
- Gastroenterology, Beijing Shijitan Hospital. Capital Medical University
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25
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Teng TZJ, Tan YP, Shelat VG. Persimmon fruit causing simultaneous small bowel and stomach obstruction. Singapore Med J 2019; 60:550. [PMID: 31663099 PMCID: PMC6875815 DOI: 10.11622/smedj.2019132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
| | - Yen Pin Tan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Vishal G Shelat
- Hepatobiliary and Pancreatic Surgery Unit, Department of General Surgery, Tan Tock Seng Hospital, Singapore
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26
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Sherf-Dagan S, Hod K, Mardy-Tilbor L, Gliksman S, Ben-Porat T, Sakran N, Zelber-Sagi S, Goitein D, Raziel A. The Effect of Pre-Surgery Information Online Lecture on Nutrition Knowledge and Anxiety Among Bariatric Surgery Candidates. Obes Surg 2019; 28:1876-1885. [PMID: 29455404 DOI: 10.1007/s11695-018-3134-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Best practices for patient education in bariatric surgery (BS) remain undefined. The aims of this study were to evaluate the effect of an online lecture on nutrition knowledge, weight loss expectations, and anxiety among BS candidates and present a new tool to assess this knowledge before BS. METHODS An interventional non-randomized controlled trial on 200 BS candidates recruited while attending a pre-BS committee. The first 100 consecutive patients were assigned to the control group and the latter 100 consecutive patients to the intervention group and were instructed to watch an online lecture of 15-min 1-2 weeks prior to surgery. All participants completed a BS nutrition knowledge and the state-trait anxiety inventory (STAI) questionnaires at the pre-BS committee and once again at the pre-surgery clinic. Body mass index (BMI), comorbidities, surgery type, marital status, and number of dietitian sessions were obtained from medical records. RESULTS Data for paired study questionnaires scores were available for 128 patients (n = 69 and n = 59 for the control and intervention groups, respectively), with a mean age and BMI of 40.3 ± 11.4 years and 41.3 ± 4.9 kg/m2, respectively. The BS nutrition knowledge and the state anxiety scores increased for both study groups at the pre-surgery clinic as compared to the pre-BS committee (P ≤ 0.028), but the improvement in the nutrition knowledge score was significantly higher for the intervention group (P = 0.030). No within or between-group differences were found for the trait anxiety items score. The "dream" and "realistic" weight goals were lower than the expected weight loss according to 70% excess weight loss (EWL) for both study groups at both time-points (P < 0.001 for all). CONCLUSION Education by an online lecture prior to the surgery improves BS nutrition knowledge, but not anxiety. ClinicalTrials.gov number: NCT02857647.
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Affiliation(s)
| | - Keren Hod
- Research division, Epidemiological service, Assuta Medical Center, Tel Aviv, Israel
| | | | - Shir Gliksman
- Department of Nutrition, Assuta Medical Center, Rishon LeZion, Israel.,School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Tair Ben-Porat
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Nasser Sakran
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel.,Department of Surgery A, Emek Medical Center, Afula, affiliated with Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Shira Zelber-Sagi
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.,Department of Gastroenterology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - David Goitein
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel.,Department of Surgery C, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Asnat Raziel
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel
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Upper Gastrointestinal Manifestation of Bezoars and the Etiological Factors: A Literature Review. Gastroenterol Res Pract 2019; 2019:5698532. [PMID: 31396274 PMCID: PMC6664490 DOI: 10.1155/2019/5698532] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 04/28/2019] [Accepted: 05/09/2019] [Indexed: 12/19/2022] Open
Abstract
A gastric bezoar is a compact mass of indigestible foreign materials that accumulate and consolidate in the stomach; however, it can be found in other sites of the gastrointestinal tract. The causative manner of this condition is complex and multifactorial. The main purpose of the review was to raise awareness among clinicians, particularly gastroenterologists, that patients with certain risk factors or comorbid conditions are predisposed to gastric bezoar formation. Early diagnosis and prompt intervention are crucial to avoid bezoar-induced complications. Upper gastrointestinal endoscopy is the standard diagnostic and therapeutic method for gastric bezoars. However, for large size bezoars, surgical intervention is needed.
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28
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Ebrahimian S, Ebrahimian S, Nadri S. Intraluminal bezoar caused obstruction and pancreatitis: A case report. Clin Case Rep 2019; 7:1040-1042. [PMID: 31110741 PMCID: PMC6510005 DOI: 10.1002/ccr3.2145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/22/2018] [Accepted: 03/23/2019] [Indexed: 01/05/2023] Open
Abstract
Acute pancreatitis from bezoar-induced obstruction is rare. We present an uncommon case report of a man with manifestations of Rapunzel syndrome with no known history of mental disorders. Surgical removal of the bezoar through gastrostomy and enterotomy in the absence of a psychiatric undertone will undoubtedly prevent a relapse.
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Affiliation(s)
- Saba Ebrahimian
- Shohada-ye Ashayer HospitalLorestan University of Medical SciencesKhorramabadIran
| | - Shadi Ebrahimian
- Shohada-ye Ashayer HospitalLorestan University of Medical SciencesKhorramabadIran
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29
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Kessler Y, Adelson D, Mardy-Tilbor L, Ben-Porat T, Szold A, Goitein D, Sakran N, Raziel A, Sherf-Dagan S. Nutritional status following One Anastomosis Gastric Bypass. Clin Nutr 2019; 39:599-605. [PMID: 30922792 DOI: 10.1016/j.clnu.2019.03.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 03/04/2019] [Accepted: 03/10/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS One Anastomosis Gastric Bypass (OAGB) has been accepted as an effective treatment for morbid obesity. However, data are scarce regarding nutritional implications of this procedure. Thus, our aim was to describe the health and nutritional status 12-20 months following OAGB surgery. METHODS A prospective cohort study on patients who underwent OAGB surgery from January 2016 to May 2017 in a large, multi-disciplinary, bariatric clinic. Pre-surgery data including demographic details, anthropometrics, co-morbidities, blood tests and lifestyle habits were obtained from the patients' medical records. Follow-up evaluations were performed 12-20 months post-surgery and data collected included anthropometrics, blood tests, eating and lifestyle parameters, adherence to follow-up regime and gastrointestinal (GI) related side effects. In addition, patients were asked to rate their overall state of health (OSH) from 0 to 100 using a visual analogue scale (VAS). RESULTS Eighty-six OAGB patients (72.1% women) were tested 14.7 ± 2.0 months post-operatively. Their mean age and BMI preoperatively were 46.1 ± 11.4 years and 42.0 ± 4.9 kg/m2, respectively. The mean % excess weight loss at 12-20 months postoperatively was 88.4 ± 19.3%. Lipid and glucose profiles were significantly improved at 12-20 months postoperatively compared to baseline (P < 0.001 for all). Relatively high proportions of nutritional deficiencies were found pre-operatively and postoperatively for iron (33.9% vs. 23.7%, P = 0.238), folate (30.9% vs. 11.8%, P = 0.004), vitamin D (56.6% vs. 17.0%, P < 0.001) and hemoglobin (16.7% vs. 42.9%, P < 0.001). Postoperatively, most participants reported taking multivitamin, calcium, vitamin D and vitamin B12 supplementation (≥62.8%), having participated in at least 6 meetings with a dietitian (51.8%) and presently doing physical activity (69.4%). The mean postoperative OSH VAS score was 88.2 ± 12.3, but most participants reported on flatulence (67.4%) and some reported on diarrhea (25.6%) as GI side effects of the surgery. CONCLUSIONS Substantial improvements in health and anthropometric parameters are found in the short-term follow-up after OAGB, with a satisfactory reported quality of life and adherence to recommendations. However, a high prevalence of some GI side effects, nutritional deficiencies and specially anemia is a matter of concern.
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Affiliation(s)
- Yafit Kessler
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel.
| | - Dana Adelson
- Faculty of Health Sciences, Joyce & Irving Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheba, Israel.
| | | | - Tair Ben-Porat
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Amir Szold
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel.
| | - David Goitein
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel; Department of Surgery C, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Nasser Sakran
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel; Department of Surgery A, Emek Medical Center, Afula, Israel; Rappaport, Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.
| | - Asnat Raziel
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel.
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Li L, Xue B, Zhao Q, Xie HQ, Luan XR, Cui Q. Observation on the curative effect of long intestinal tube in the treatment of phytobezoar intestinal obstruction. Medicine (Baltimore) 2019; 98:e14861. [PMID: 30882686 PMCID: PMC6426573 DOI: 10.1097/md.0000000000014861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The aim of the study was to observe the curative effect of long intestinal tube (LT) in the treatment of phytobezoar intestinal obstruction.We performed a retrospective study of patients with phytobezoar intestinal obstruction who underwent decompression with different tube insertion method. A total of 80 patients were collected and divided into nasogastric tube (NGT) group (n = 36) and LT group (n = 44) between August 2015 and August 2018 at our hospital. Univariate analysis was used to assess the clinical efficacy of 2 groups of patients.There were no significant differences in the mean age, sex ratio, and previous surgical history between the 2 groups. There were statistically significant differences between the 2 groups in terms of improvement time of clinical indications (4.2 ± 1.4 vs 2.5 ± 0.6 days; P = .008), liquid decompression amount on the first day of catheterization (870.4 ± 400.8 vs 1738.4 ± 460.2 mL; P = .000), transit operation rate (4/36 vs 0/44; P = .023), clinical cure rate (25/36 vs 40/44; P = .014), total treatment efficiency (32/36 vs 44/44; P = .023), and total hospitalization cost (3.25 ± 0.39 vs 2.07 ± 0.41 ¥ ten thousand; P = .000).The curative effect of LT in the treatment of phytobezoar intestinal obstruction is accurate and reliable, which can effectively improve the clinical symptoms of patients, comprehensively improve the non-surgical rate of intestinal obstruction treatment, reduce the total cost of hospitalization, and is worthy of promotion in clinical application.
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Affiliation(s)
- Liang Li
- Department of Gastrointestinal Surgery
| | - Bing Xue
- Department of Internal Medicine, Zibo Central Hospital of Shandong University, Zibo, Shandong, China
| | | | | | | | - Qing Cui
- Department of Gastrointestinal Surgery
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Endoscopic versus Surgical Intervention for Jejunal Bezoar Formation. ACG Case Rep J 2019; 5:e87. [PMID: 30775390 PMCID: PMC6358576 DOI: 10.14309/crj.2018.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 09/11/2018] [Indexed: 11/24/2022] Open
Abstract
Bezoar-induced small bowel obstruction is a rare entity, but it should be highly suspected in those with prior abdominal or bariatric surgery. The cornerstone of treatment for intestinal bezoars has been surgical exploration to relieve the obstruction. We present a patient with obstructive jejunal phytobezoar formation that was relieved via an endoscopic approach rather than a surgical modality.
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32
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Case Report: Seaweed Bezoar Masquerading as a Malignant Obstruction. Case Rep Surg 2018; 2018:3829271. [PMID: 30510833 PMCID: PMC6230413 DOI: 10.1155/2018/3829271] [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: 07/16/2018] [Accepted: 10/03/2018] [Indexed: 11/18/2022] Open
Abstract
Bezoars represent a rare cause of small bowel obstruction (SBO). Nonoperative management of bezoars includes use of endoscopy with mechanical or chemical dissolution methods. When obstruction persists, surgical intervention becomes necessary. Here, we present the case of an Asian woman with a SBO secondary to a phytobezoar masquerading as a malignancy. She presented with two days of acute-on-chronic abdominal pain that started after eating seaweed. Initial computed tomography (CT) scan showed a SBO with a jejunal transition point and ill-defined liver lesions, worrisome for a malignant obstruction with liver metastases. Further imaging, however, showed the resolution of these artifacts. Subsequent laparotomy revealed a small bowel loop with copious obstructing seaweed. A distal stricture was palpated, and the involved segment was resected. Intraoperative liver ultrasound was negative, and final pathology revealed benign small intestine with a mild stricture. Given the rarity of bezoar-related obstructions, the diagnosis is often delayed particularly when confounding factors exist such as our patient's concomitant hepatic findings. Contrast-enhanced CT has a high sensitivity but a lower specificity in identifying bezoars. A high index of suspicion is therefore necessary especially when managing higher risk patients.
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34
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Endoscopic versus Surgical Intervention for Jejunal Bezoar Formation. ACG Case Rep J 2018. [DOI: 10.14309/02075970-201805120-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Amjad W, Upadhya G, Hurairah A, Iqbal S. Endoscopic shaving of hair in a gastric bypass patient with a large bezoar. BMJ Case Rep 2017; 2017:bcr-2017-220923. [PMID: 28993354 DOI: 10.1136/bcr-2017-220923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Trichotillomania can be associated with the formation of trichobezoars (hair ball) usually located in the stomach. Trichobezoars may lead to complications including bowel obstruction, and perforation. Patients with a history of diabetes, certain psychiatric disorders, prior gastric surgery and poor mastication ability are at an increased risk of developing bezoars. We are presenting a case of patient who suffered from a large, recurrent trichobezoar, who had a history of gastric bypass surgery as well as trichotillophagia. The endoscopic method used to remove the large bezoar will also be discussed. We have reviewed the cases published, in which patients developed bezoars after undergoing gastric bypass surgery. The purpose of this study is to raise awareness among clinicians that patients with certain psychiatric issues who had prior gastric surgeries, are at eminent risk of bezoar formation. A multidisciplinary approach including cognitive behavioural therapy, dietary education and pharmacotherapy should be taken to prevent complications.
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Affiliation(s)
- Waseem Amjad
- Internal Medicine, Northwell-Long Island Jewish Forest Hills Hospital, Allama Iqbal Medical College, Forest Hills, New York, USA
| | - Gautham Upadhya
- Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, , New York, USA
| | - Abu Hurairah
- Department of Gastroenterology, SUNY Downstate Medical Center, New York, USA
| | - Shahzad Iqbal
- Department of Gastroenterology, Island Gastroenterology Consultants, West Islip, New York, USA
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Sheikh AB, Akhtar A, Nasrullah A, Haq S, Ghazanfar H. Role of Laparoscopy in the Management of Acute Surgical Abdomen Secondary to Phytobezoars. Cureus 2017; 9:e1363. [PMID: 28721331 PMCID: PMC5513738 DOI: 10.7759/cureus.1363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
A bezoar is a collection of indigestible material found in the alimentary canal, which can cause mechanical obstruction of the gastrointestinal tract. Phytobezoar is a variant composed of mostly plant material and indigestible fiber. Phytobezoar is a rare cause of small bowel obstruction (SBO) and happens more commonly in patients with risk factors predisposing to impaired gastrointestinal motility. We present a rare case of SBO secondary to phytobezoar in a 60-year-old female patient with type 2 diabetes. There was no prior history of any abdominal surgery. The abdominal computed tomography (CT) scan was inconclusive. Laparoscopy was found to be an effective diagnostic and therapeutic procedure in this patient.
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Affiliation(s)
| | - Aisha Akhtar
- Surgery, Texas Tech Health Sciences Center Lubbock
| | - Adeel Nasrullah
- Department of Internal Medicine, Shifa International Hospital
| | - Shujaul Haq
- Department of Internal Medicine, Shifa International Hospital
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[A 67-year old man with epigastric pain]. Internist (Berl) 2017; 58:1207-1212. [PMID: 28523367 DOI: 10.1007/s00108-017-0257-5] [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: 10/19/2022]
Abstract
A 67-year-old man suffering from epigastric pain showed a phytobezoar in the endoscopy. Therapy with Coca Cola® and enzymes was initiated. The (partial) lysis led to a migration of the bezoar into the ileum, resulting in a small bowel obstruction. After removal of the remaining bezoar via ileotomy a secondary pneumatosis intestinalis occurred. As a rare finding the (phyto-)bezoar should be considered as a differential diagnosis of abdominal pain - especially considering the rising numbers of bariatric surgery, which is a potential risk factor. Furthermore, intestinal obstruction after migration has to be considered as a relevant complication of treatment.
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