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Delgado Galan M, Rabago LR. Has Coca-Cola treatment become the first-line therapy for gastric bezoars, both in general and specifically for western countries? World J Gastrointest Endosc 2024; 16:237-243. [PMID: 38813574 PMCID: PMC11130549 DOI: 10.4253/wjge.v16.i5.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/10/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024] Open
Abstract
Phytobezoars is a rare disease and less common in Western countries. The stomach is the primary site for these formations, and endoscopic treatment involving fragmentation and extraction has traditionally been the most effective approach. However, medical treatments using enzymatic and chemical agents, such as cellulase and Coca-Cola, aimed at dissolving the bezoars, have also been utilized, showing varying degrees of resolution success. Notably, the oral dissolution treatment with Coca-Cola has emerged as a promising, simpler, and more cost-effective method. The study by Liu et al represents an important step in clinical research on this topic, despite some limitations that need addressing for a more comprehensive understanding of its findings. Key considerations for future research include sample size calculation, endoscopic procedure details, outpatient vs. inpatient treatment, and detailed cost calculations. The study's exclusions, such as patients with upper gastric surgery, phytobezoars older than 14 d, and cases of gastroparesis, limit its applicability to broader populations, especially in Western countries. Given the promising outcomes of the Coca-Cola treatment, it's advocated as a first-line therapy for phytobezoars. Nonetheless, further research is essential to overcome these limitations. However special situations such as perforation or small bowel obstruction will require surgical treatment.
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Affiliation(s)
| | - Luis Ramon Rabago
- Department of Gastroenterology, Hospital San Rafael, Madrid 28016, Spain
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2
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Miłow JJ, Joźwiak J. Expect the unexpected: bezoar-caused gastric perforation in the 19-year-old patient, after traffic accident. POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2024; 52:128-131. [PMID: 38518244 DOI: 10.36740/merkur202401119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
A 19-year-old female involved in a traffic accident presented to the Emergency Room (ER) with no trauma-related symptoms but a palpable mass in the epigastrium. Imaging revealed a massive trichobezoar causing gastric perforation. Urgent laparotomy was performed, and a 1.5-kilogram bezoar was removed, along with repairing coexisting gastric ulcers. The patient had a history of trichophagia, suggesting a psychiatric association. This case highlights the potential of trichobezoars to cause gastric perforation, even in patients admitted for unrelated reasons. CT-scan proves effective in diagnosing such cases. While a traffic accident might be a plausible cause, the presence of a bezoar can elevate the risk of complications. Psychiatric evaluation is recommended when trichophagia is identified. The study underscores the need for vigilance in unexpected scenarios, demonstrating the importance of multidisciplinary approaches in managing such cases.
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Affiliation(s)
- Jerzy Janusz Miłow
- MARIA SKŁODOWSKA-CURIE VOIVODESHIP SPECIALIST HOSPITAL IN ZGIERZ, ZGIERZ, POLAND
| | - Justyna Joźwiak
- MARIA SKŁODOWSKA-CURIE VOIVODESHIP SPECIALIST HOSPITAL IN ZGIERZ, ZGIERZ, POLAND
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3
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Kocic M, Rasic P, Marusic V, Prokic D, Savic D, Milickovic M, Kitic I, Mijovic T, Sarajlija A. Age-specific causes of upper gastrointestinal bleeding in children. World J Gastroenterol 2023; 29:6095-6110. [PMID: 38186684 PMCID: PMC10768410 DOI: 10.3748/wjg.v29.i47.6095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/05/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023] Open
Abstract
The etiology of upper gastrointestinal bleeding (UGIB) varies by age, from newborns to adolescents, with some of the causes overlapping between age groups. While particular causes such as vitamin K deficiency and cow's milk protein allergy are limited to specific age groups, occurring only in neonates and infants, others such as erosive esophagitis and gastritis may be identified at all ages. Furthermore, the incidence of UGIB is variable throughout the world and in different hospital settings. In North America and Europe, most UGIBs are non-variceal, associated with erosive esophagitis, gastritis, and gastric and duodenal ulcers. In recent years, the most common causes in some Middle Eastern and Far Eastern countries are becoming similar to those in Western countries. However, variceal bleeding still predominates in certain parts of the world, especially in South Asia. The most severe hemorrhage arises from variceal bleeding, peptic ulceration, and disseminated intravascular coagulation. Hematemesis is a credible indicator of a UGI source of bleeding in the majority of patients. Being familiar with the most likely UGIB causes in specific ages and geographic areas is especially important for adequate orientation in clinical settings, the use of proper diagnostic tests, and rapid initiation of the therapy. The fundamental approach to the management of UGIB includes an immediate assessment of severity, detecting possible causes, and providing hemodynamic stability, followed by early endoscopy. Unusual UGIB causes must always be considered when establishing a diagnosis in the pediatric population because some of them are unique to children. Endoscopic techniques are of significant diagnostic value, and combined with medicaments, may be used for the management of acute bleeding. Finally, surgical treatment is reserved for the most severe bleeding.
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Affiliation(s)
- Marija Kocic
- Department of Gastroenterology, Hepatology and Nutrition, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
| | - Petar Rasic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
| | - Vuk Marusic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Dragan Prokic
- Department of Gastroenterology, Hepatology and Nutrition, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Djordje Savic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Maja Milickovic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Ivana Kitic
- Department of Gastroenterology, Hepatology and Nutrition, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Tanja Mijovic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
| | - Adrijan Sarajlija
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
- Pediatric Day Care Hospital Department, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
- Faculty of Medicine, University of Eastern Sarajevo, Foča 73300, Bosnia and Herzegovina
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4
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Muhtaroğlu A, Yiğit M, Demir H, Dülger U, Doğangün M, Küçük İF, Altintoprak F. Evaluation of the location, number and diameter of bezoars in patients with a history of previous gastrointestinal surgery. Eur J Trauma Emerg Surg 2023; 49:1783-1789. [PMID: 36609597 DOI: 10.1007/s00068-023-02220-0] [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: 12/12/2022] [Accepted: 12/31/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Bezoars are foreign bodies developed due to the swallowing of indigestible substances in the stomach that accumulate in the lumen of the gastrointestinal tract. This study aimed to compare the location, size, and diameter of bezoars between patients with and without a history of previous gastrointestinal surgery and between operated and non-operated patients retrospectively. METHODS A total of 188 patients who presented to our gastroenterology clinic and in whom bezoar was suspected on clinical examination and the diagnosis confirmed through abdominal CT scans were included in the study. The patients were divided into two groups; patients with a history of previous gastrointestinal surgery were assigned to Group 1 (n = 70), and those who had no history of previous surgery (n = 118) to Group 2. RESULTS The mean age was found as 56.16 ± 15.75 years in Group 1 and 57.71 ± 15.95 years in Group 2. The mean bezoar width was significantly higher in Group 1 (p = 0.049). The mean bezoar length was significantly higher in Group 1 (p = 0.004). Considering localization of bezoars, the rate of patients who underwent enterotomy (80%) was statistically significantly higher than the patients who underwent gastrotomy (23.50%), gastrotomy + milking (28.60%) and milking (44.70%) in the operations performed in the jejunum. CONCLUSION Bezoars are a rare cause of intestinal obstruction. The median width and length of the bezoars were significantly higher in patients with a history of previous gastric surgery. There was no significant difference in other parameters. The most common localization was jejunum.
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Affiliation(s)
- Ali Muhtaroğlu
- Department of General Surgery, Giresun University Faculty of Medicine, Giresun University Training and Research Hospital, Aksu District, Mehmet İzmen Street, Number: 145, Giresun, 28100, Turkey.
| | - Merve Yiğit
- Department of General Surgery, Sakarya University Faculty of Medicine, Serdivan, Turkey
| | - Hakan Demir
- Department of General Surgery, Sakarya Training And Research Hospital, Sakarya, Turkey
| | - Uğur Dülger
- Department of General Surgery, Sakarya University Faculty of Medicine, Serdivan, Turkey
| | - Muhammed Doğangün
- Department of General Surgery, Sakarya Training And Research Hospital, Sakarya, Turkey
| | - İbrahim Furkan Küçük
- Department of General Surgery, Sakarya University Faculty of Medicine, Serdivan, Turkey
| | - Fatih Altintoprak
- Department of General Surgery, Sakarya University Faculty of Medicine, Serdivan, Turkey
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5
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Uttam S, Kumar S, Singh S. A Rare Case of Rapunzel Syndrome Presenting with Perforation Peritonitis. Cureus 2023; 15:e42440. [PMID: 37637645 PMCID: PMC10449238 DOI: 10.7759/cureus.42440] [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: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Rapunzel syndrome with gastric perforation is an extremely rare presentation of trichobezoars of the stomach. Trichobezoars may vary greatly in presentation ranging from benign symptoms like vague abdominal pain and anorexia to grave complications like perforation peritonitis. A sincere evaluation of any underlying psychiatric illnesses, usually trichotillomania and trichophagia, holds the key to preventing recurrences in patients of trichobezoar. A 15-year-old adolescent female presented with signs and symptoms of enteric perforation with a history of trichotillomania and trichophagia. Exploratory laparotomy of the patient revealed anterior gastric perforation with a huge gastric trichobezoar that extended into the duodenum and jejunum, hence establishing the diagnosis of Rapunzel syndrome.
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Affiliation(s)
- Sarthak Uttam
- General Surgery, Uttar Pradesh University of Medical Sciences, Etawah, IND
| | - Shesh Kumar
- General Surgery, Uttar Pradesh University of Medical Sciences, Etawah, IND
| | - Shivali Singh
- General Surgery, Uttar Pradesh University of Medical Sciences, Etawah, IND
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6
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Kang WR, Park SY, You HS, Kim DH, Park CH, Choi SK, Kim HS. A Single-center 12-year Experience of Patients with Gastrointestinal Bezoars. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2023; 81:253-258. [PMID: 37350520 DOI: 10.4166/kjg.2023.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/06/2023] [Accepted: 04/06/2023] [Indexed: 06/24/2023]
Abstract
Background/Aims Gastrointestinal (GI) bezoars are relatively rare diseases with clinical characteristics and treatment modalities that depend on the location of the bezoars. This study evaluated the clinical characteristics and treatment outcomes in patients with GI bezoars. Methods Seventy-five patients diagnosed with GI bezoars were enrolled in this study. Data were collected on the demographic and clinical characteristics and the characteristics of the bezoars, such as type, size, location, treatment modality, and clinical outcomes. Results Among the 75 patients (mean age 71.2 years, 38 males), 32 (42.6%) had a history of intra-abdominal surgery. Hypertension (43%) and diabetes (30%) were common morbidities. The common location of the bezoars was the stomach in 33 (44%) and the small intestine in 33 (44%). Non-surgical management, including adequate hydration, chemical dissolution, and endoscopic removal, was successful in 2/2 patients with esophageal bezoars, 26/33 patients with gastric bezoars, 7/9 patients with duodenal bezoars, and 20/33 patients with small intestinal bezoars. The remaining patients had undergone surgical management. Conclusions The management of GI bezoars requires multidisciplinary approaches, including the appropriate correction of fluid and electrolyte imbalances, chemical dissolution, and endoscopic and surgical treatments.
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Affiliation(s)
- Woo Rim Kang
- Department of Internal Medicine, Chonnam National Medical School, Gwangju, Korea
| | - Seon-Young Park
- Department of Internal Medicine, Chonnam National Medical School, Gwangju, Korea
| | - Hye-Su You
- Department of Internal Medicine, Chonnam National Medical School, Gwangju, Korea
| | - Dong Hyun Kim
- Department of Internal Medicine, Chonnam National Medical School, Gwangju, Korea
| | - Chang Hwan Park
- Department of Internal Medicine, Chonnam National Medical School, Gwangju, Korea
| | - Sung Kyu Choi
- Department of Internal Medicine, Chonnam National Medical School, Gwangju, Korea
| | - Hyun-Soo Kim
- Department of Internal Medicine, Chonnam National Medical School, Gwangju, Korea
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7
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A rare case after Nissen fundoplication: Esophageal bezoar. JOURNAL OF SURGERY AND MEDICINE 2023. [DOI: 10.28982/josam.7741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
A 33-year-old female patient was admitted to our clinic with complaints of nausea and vomiting for two days and the inability to tolerate food. The patient had a Nissen fundoplication three years ago. Computed tomography (CT) showed a bezoar image in the distal esophagus. The patient stated that the symptoms began after he ate a persimmon two days ago. The patient underwent esophagogastroduodenoscopy. A bezoar was observed in the distal esophagus at the esophagogastric junction. No pathology was observed in the stomach and duodenum. After the bezoar was shredded with a snare and removed with a retrieval snare. Here, we further describe this case of a bezoar that caused ileus in the distal esophagus after a fundoplication operation.
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8
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Maldonado Cardona KE, Ruiz Rodríguez JG, Aguirre Ayala JR, Sánchez Orozco AA, Jimenez Espinosa JA, Pereira Molina SF, Villamar Barrera MA. A hairy endoscopy. Endoscopy 2022; 55:E266-E267. [PMID: 36427502 PMCID: PMC9831780 DOI: 10.1055/a-1966-0584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - José R. Aguirre Ayala
- Unit of Gastroenterology, Roosevelt Hospital of Guatemala, Guatemala City, Guatemala
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9
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Muñiz-Muñoz M, Segovia-Alonso P, Delgado-Álvarez MP, Villanueva-Hernández R. Esophageal bezoar: A multidisciplinary approach. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2022; 87:394-396. [PMID: 35661639 DOI: 10.1016/j.rgmxen.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/03/2021] [Indexed: 11/17/2022]
Affiliation(s)
- M Muñiz-Muñoz
- Servicio de Aparato Digestivo, Hospital Nuestra Señora de Sonsoles, Complejo Asistencial de Ávila, Ávila, Spain.
| | - P Segovia-Alonso
- Servicio de Aparato Digestivo, Hospital Nuestra Señora de Sonsoles, Complejo Asistencial de Ávila, Ávila, Spain
| | - M P Delgado-Álvarez
- Servicio de Aparato Digestivo, Hospital Nuestra Señora de Sonsoles, Complejo Asistencial de Ávila, Ávila, Spain
| | - R Villanueva-Hernández
- Servicio de Aparato Digestivo, Hospital Nuestra Señora de Sonsoles, Complejo Asistencial de Ávila, Ávila, Spain
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10
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Khalifa MB, Ghannouchi M, Nacef K, Chaouch A, Sellami M, Boudokhane M. Trichobezoar: A case report of a double gastric and ilial localization revealed by an occlusion. Int J Surg Case Rep 2022; 91:106782. [PMID: 35077999 PMCID: PMC8787762 DOI: 10.1016/j.ijscr.2022.106782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/16/2022] [Accepted: 01/16/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction and importance Case presentation Clinical discussion Conclusion Trichobezoar is a compact conglomeration of swallowed hair. It's a rare disease and presents both a diagnostic and therapeutic challenge. Endoscopic extraction represents the therapeutic approach for uncomplicated forms. Surgical treatment remains the main therapeutic means of trichobezoar.
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Affiliation(s)
- Mohamed Ben Khalifa
- General Surgery Department, Tahar sfar Hospital Mahdia, Faculty of Medicine, University of Monastir, Tunisia.
| | - Mossaab Ghannouchi
- General Surgery Department, Tahar sfar Hospital Mahdia, Faculty of Medicine, University of Monastir, Tunisia
| | - Karim Nacef
- General Surgery Department, Tahar sfar Hospital Mahdia, Faculty of Medicine, University of Monastir, Tunisia
| | - Asma Chaouch
- General Surgery Department, Tahar sfar Hospital Mahdia, Faculty of Medicine, University of Monastir, Tunisia
| | - Mohamed Sellami
- General Surgery Department, Tahar sfar Hospital Mahdia, Faculty of Medicine, University of Monastir, Tunisia
| | - Moez Boudokhane
- General Surgery Department, Tahar sfar Hospital Mahdia, Faculty of Medicine, University of Monastir, Tunisia
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11
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Delimpaltadaki DG, Gkionis IG, Flamourakis ME, Strehle AF, Bachlitzanakis EN, Giakoumakis MI, Christodoulakis MS, Spiridakis KG. A rare giant gastric trichobezoar in a young female patient: Case report and review of the literature. Clin Case Rep 2021; 9:e05152. [PMID: 34938545 PMCID: PMC8665721 DOI: 10.1002/ccr3.5152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/07/2021] [Accepted: 11/19/2021] [Indexed: 12/13/2022] Open
Abstract
A bezoar is an aggregate of undigested foreign materials that accumulate in the gastrointestinal tract and may cause serious symptoms or even life-threatening complications. Trichobezoars, a subtype of bezoars, are a rare condition usually occurring in females with psychiatric disorders, with Rapunzel syndrome being an uncommon form of trichobezoar.
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12
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Head WT, Parrado RH, McDuffie L. Rapunzel Syndrome: A Rare Case of Small Bowel Intussusception in a Child. Cureus 2021; 13:e17911. [PMID: 34660106 PMCID: PMC8510510 DOI: 10.7759/cureus.17911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2021] [Indexed: 12/11/2022] Open
Abstract
Trichobezoars are indigestible masses of ingested hair commonly found in the stomach, often presenting with symptoms related to gastric outlet obstruction and severity related to the mass’s size and location. Gastrointestinal complications include ulceration, perforation, peritonitis, pancreatitis, obstructive jaundice, pneumatosis intestinalis, and intussusception. Management of trichobezoars differs from that of other forms of bezoars, which can often be addressed with chemical dissolution. Trichobezoars are high-density structures that are also resistant to enzymatic and pharmacotherapy degradation, and as such, they require endoscopic, or more commonly, surgical removal. Here, we present the diagnosis and surgical management of a 12-year-old female with a large trichobezoar causing gastric outlet obstruction, with an associated Rapunzel syndrome manifesting as multiple small intestinal intussusceptions.
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Affiliation(s)
- William T Head
- Surgery, Medical University of South Carolina, Charleston, USA
| | - Raphael H Parrado
- Pediatric Surgery, Medical University of South Carolina, Charleston, USA
| | - Lucas McDuffie
- Pediatric Surgery, Medical University of South Carolina, Charleston, USA
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13
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Wang TT, He JJ, Liu J, Chen WW, Chen CW. Acute pancreatitis and small bowel obstruction caused by a migratory gastric bezoar after dissolution therapy: A case report. World J Clin Cases 2021; 9:3114-3119. [PMID: 33969098 PMCID: PMC8080734 DOI: 10.12998/wjcc.v9.i13.3114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/08/2021] [Accepted: 03/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Bezoars are conglomerates of indigestible foreign material that can be found in the gastrointestinal tract. Gastric ulcer, gastrointestinal perforation, and intestinal obstruction are the main complications. Acute pancreatitis secondary to bezoar is rare. Here, we present a rare case of a migratory gastric bezoar complicated by acute pancreatitis and small bowel obstruction after dissolution therapy.
CASE SUMMARY A-65-year-old woman underwent gastroscopy because of epigastric pain, which revealed a huge bezoar and a gastric ulcer 10 d prior. The patient was discharged with a prescription of drinking 1 L Coca-Cola daily for 6 d, without repeat gastroscopy. However, she suddenly developed epigastric pain, nausea and vomiting for 3 d. Abdominal computed tomography (CT) revealed mild inflammation of the pancreas. Magnetic resonance cholangiopancreatography showed no abnormalities in the pancreatic duct or common bile duct. The nasogastric tube still showed drainage of more than 1.6 L of dark fluid each day after symptomatic treatment. Abdominal CT re-examination suggested intestinal obstruction. Esophagogastroduodenoscopy revealed a huge yellowish hard mass in the jejunal lumen, and we used the basket and net to fragment the bezoar. She was discharged with a good outcome.
CONCLUSION Endoscopic therapy is the first choice for gastric bezoars. When mechanical disintegration cannot be achieved, timing of repeat endoscopy is important during Coca-Cola dissolution therapy.
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Affiliation(s)
- Ting-Ting Wang
- Department of Gastroenterology, The First Clinical Medical College, Dalian Medical University, Dalian 116044, Liaoning Province, China
| | - Jia-Jun He
- Department of Gastroenterology, The First Clinical Medical College, Dalian Medical University, Dalian 116044, Liaoning Province, China
| | - Jun Liu
- Endoscopy Center, Department of Gastroenterology, Clinical Medical College, Yangzhou University, Yangzhou 225009, Jiangsu Province, China
| | - Wei-Wei Chen
- Endoscopy Center, Department of Gastroenterology, Clinical Medical College, Yangzhou University, Yangzhou 225009, Jiangsu Province, China
| | - Chao-Wu Chen
- Endoscopy Center, Department of Gastroenterology, Clinical Medical College, Yangzhou University, Yangzhou 225009, Jiangsu Province, China
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14
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Doughty M, Alookaran J, Rhoads M, Dahm PH. Restrictive Lung Pattern: A Rare Complication of a Phytobezoar. JPGN REPORTS 2021; 2:e056. [PMID: 37207073 PMCID: PMC10191542 DOI: 10.1097/pg9.0000000000000056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 01/16/2021] [Indexed: 05/21/2023]
Affiliation(s)
- Morgan Doughty
- From the Department of Pediatrics, Division of Critical Care Medicine, McGovern Medical School, part of UTHealth, The University of Texas Health Science Center at Houston, Houston, TX; and
| | - Jane Alookaran
- Department of Pediatrics, Division of Gastroenterology, McGovern Medical School, part of UTHealth, The University of Texas Health Science Center at Houston, Houston, TX
| | - Marc Rhoads
- Department of Pediatrics, Division of Gastroenterology, McGovern Medical School, part of UTHealth, The University of Texas Health Science Center at Houston, Houston, TX
| | - Paul H. Dahm
- From the Department of Pediatrics, Division of Critical Care Medicine, McGovern Medical School, part of UTHealth, The University of Texas Health Science Center at Houston, Houston, TX; and
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15
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Hemmasi G, Zanganeh E, Hosseini SA, Alimadadi M, Ahmadi A, Hajiebrahimi S, Seyyedmajidi M. Risk factors, endoscopic findings, and treatments in upper gastrointestinal bezoars: multi-center experience in Iran. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2021; 14:160-164. [PMID: 33968343 PMCID: PMC8101514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIM The current study aimed to investigate the risk factors, endoscopic findings, and treatments of upper gastrointestinal bezoars. BACKGROUND Bezoars are compact masses formed by the accumulation of dietary fiber, undigested food, hair, or medications. The majority of bezoars are asymptomatic, but they may cause serious symptoms or even life-threatening events such as bleeding, obstruction, or perforation. METHODS This retrospective study was conducted in three gastroenterology clinics between January 2016 and December 2019. Bezoars were detected in 109 of 15,830 endoscopy records (0.68%). RESULTS A total of 103 patients (52.4% male) were enrolled in this study. Mean patient age was 60.5±11.3 years. The most frequent risk factors were history of gastric surgery (25.2%), diabetes mellitus (21.3%), hypothyroidism (15.5%), trichophagia (5.8%), and anxiety disorders (2.9%), respectively. The most common endoscopic findings were peptic ulcers (34.9%), erosive gastritis/duodenitis (12.6%), and reflux esophagitis (10.6%). While bezoars were most commonly observed in the stomach (84.4%), the majority of them were phytobezoars (92.2%). The mean number of endoscopic interventions for each patient was 1.5 (range, 1-4). Endoscopy was successful in removing bezoars in 85.4%. CONCLUSION The synergistic effect of multiple factors for a long time, such as gastrointestinal surgery, diabetes mellitus or psychiatric disorders, may lead to bezoar formation. These risk factors should be avoided or treated in order to prevent bezoar formation and subsequent life-threatening complications.
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Affiliation(s)
| | - Elahe Zanganeh
- Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences, Gorgan, Iran
| | | | - Mehdi Alimadadi
- Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences, Gorgan, Iran
| | - Anahita Ahmadi
- Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences, Gorgan, Iran
| | - Shahin Hajiebrahimi
- Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences, Gorgan, Iran
| | - Mohammadreza Seyyedmajidi
- Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences, Gorgan, Iran
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Liu LN, Wang L, Jia SJ, Wang P. Clinical Features, Risk Factors, and Endoscopic Treatment of Bezoars: A Retrospective Analysis from a Single Center in Northern China. Med Sci Monit 2020; 26:e926539. [PMID: 33027245 PMCID: PMC7549533 DOI: 10.12659/msm.926539] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background The aims of this study were to summarize the clinical characteristics and risk factors for bezoars and to analyze the effectiveness and safety of the endoscopic treatment of bezoars. Material/Methods From January 2015 to February 2020, 75 of the 23 950 patients who underwent gastroscopic examination in our medical center were diagnosed with bezoars. Clinical and treatment information for these patients was collected retrospectively and analyzed. Results The detection rate of bezoars was 0.31%. Risk factors included the time of year (autumn and winter seasons), alcohol consumption, hypertension, diabetes, and residing in the Mentougou district, which is rich in hawthorn and persimmon. Abdominal pain (90.7%) and bloating (80.0%) were common clinical symptoms of bezoars, while gastric mucosa erosion (90.7%) and gastric ulcers (60%) were common manifestations on endoscopic examination. Six patients with bezoars were successfully discharged after drug treatment. The success rate for bezoars treated by gastroscopic lithotripsy was 94.2% (65/69 patients). The factors affecting the therapeutic effect of bezoars include patient age (P=0.025) and bezoar size (P=0.042). Patients with bezoars larger than 9 cm were significantly more likely to have intestinal obstructions than were patients with bezoars smaller than 9 cm (P<0.001). Conclusions Bezoars mainly occur in elderly patients with diseases such as gastrointestinal dyspraxia and diabetes, and are most common in hawthorn and persimmon producing areas. Endoscopic treatment is safe and effective for bezoars in general, but intestinal obstruction should be considered for bezoars larger than 9 cm.
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Affiliation(s)
- Lin-Na Liu
- Department of Gastroenterology, Peking University Shougang Hospital, Beijing, China (mainland)
| | - Lei Wang
- Department of Urology, Peking University Shougang Hospital, Beijing, China (mainland).,Peking University Wujieping Urology Center, Peking University Health Science Center, Beijing, China (mainland)
| | - Shu-Juan Jia
- Department of Gastroenterology, Peking University Shougang Hospital, Beijing, China (mainland)
| | - Peng Wang
- Department of Gastroenterology, Peking University Shougang Hospital, Beijing, China (mainland)
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