Efferent limb of gastrojejunostomy obstruction by a whole okra phytobezoar: Case report and brief review

Endoscopic Treatment of Postoperative Bleeding, Bezoars, and Foreign Bodies

Altered gastrointestinal anatomy is common in patients with inflammatory bowel disease, particularly in those who underwent bowel surgery. Commonly performed surgeries are bowel resection and anastomosis and strictureplasty for Crohn's disease; and restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis. The area of anastomosis and suture line is at the greatest risk for the development of postoperative bleeding. Altered bowel anatomy, especially the presence of strictures, strictureplasty, or structural or functional pouch outlet obstruction, puts these patients at risk for bezoar formation and foreign body retention, including video endoscopy capsule. This article will focus on postoperative bleeding, bezoar formation, and video capsule retention in patients with inflammatory bowel disease. Endoscopic management of these conditions is useful and is becoming an increasingly popular alternative to surgery.

Gastric phytobezoars as a very unusual cause of gastric outlet obstruction

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.

Small bowel obstruction due to a phytobezoar thirty years after Roux-en-Y gastrojejunostomy: A case report

INTRODUCTION

We present a case of a delayed small bowel obstruction due to a phytobezoar in a patient with a previous surgical history.

PRESENTATION OF CASE

A 73-year-old male patient presented with vomiting and obstipation for a week. His past surgical history included a Roux-en-y gastrojejunostomy due to a surgical management for peptic ulcer disease 30 years ago. Abdominal computed tomography demonstrated a dilation of small bowel with air-fluid levels. He was diagnosed with acute bowel obstruction. On exploration, we found a compressible mass 150 cm from the jejunojejunostomy anastomosis. An enterotomy was performed and the mass was milked back. It was a phytobezoar. After the bezoar removal, his complaints relieved completely.

DISCUSSION

Small bowel obstruction after abdominal surgery (Roux-en-y gastrojejunostomy) is a complication that may present early or late for many causes. One of the unusual underlying causes is phytobezoar.

CONCLUSION

This case aims to raise awareness of phytobezoar as a cause of small bowel obstruction even in delayed presentation.

Endoscopic shaving of hair in a gastric bypass patient with a large bezoar

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.

Frequency, manifestations and management of bezoars in ileal pouches

Background and Aim To evaluate the frequency, diagnosis and management of ileal pouch bezoars. Methods Patients diagnosed with ileal pouch bezoars at the P ouch C enter at Cleveland Clinic from 2002 to 2013 were included. Demographic, clinical and endoscopic features, management and outcomes were evaluated. Results Twelve patients with ileal pouch bezoars were enrolled, including five (0.4%) of 1390 patients with J ‐pouch and seven (13.0%) of 54 with continent ileostomy (P  < 0.001). Males accounted for 25% (n  = 3) of the cohort. Mean age at time of detection was 61.5 ± 10.3 years. Of the 12 patients, six (50.0%) had phytobezoars, four (33.3%) had lithobezoars, one (8.3%) had pharmacobezoar and one (8.3%) had a retained‐J ackson‐P ratt drain. Median number of harvested bezoars was one (range: 1–224), and mean diameter was 4.0 ± 2.4 cm. Bezoars were located at the pouch body in eight (66.7%) patients, pouch inlet in two (16.7%), pouch‐anal anastomosis in one (8.3%) and efferent limb in one (8.3%). Ten patients (83.3%) were symptomatic, including seven (58.3%) with partial bowel obstructive symptoms. Eleven patients (91.7%) were initially managed with endoscopic treatment including basket, R othN et® , mechanical lithotripsy T ripod and snares. After a median of one (1–3) endoscopic therapy, bezoars were successfully removed in seven patients (58.3%). Surgical intervention was required in the remaining five patients (41.7%). Conclusions Ileal pouch bezoars appeared to be more frequently encountered in patients with continent ileostomies than in those with J ‐pouches. Endoscopic management seemed to be effective in some patients, whereas surgical intervention was needed in others.