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Milosevic S, Kovac JD, Lazic L, Mitrovic M, Stosic K, Basaric D, Tadic B, Stojkovic S, Rasic S, Ivanovic N, Skrobic O. " Bezoar Egg"-A Rare Cause of Small Bowel Obstruction. Diagnostics (Basel) 2024; 14:360. [PMID: 38396399 PMCID: PMC10887705 DOI: 10.3390/diagnostics14040360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Small bowel obstruction is a frequent medical condition with various causes, the most common being postoperative adhesions, volvulus, intussusception, hernias, and tumors. A bezoar-induced blockage of the small intestine is a rare condition that accounts for approximately 4% of all small bowel obstruction cases. Herein, we present the case report of a 71-year-old patient with diffuse abdominal pain caused by a small bowel obstruction due to a calcified bezoar (bezoar egg) resulting from a post-radiation intestinal stricture. The patient underwent a small bowel excision with the extraction of the bezoar, after which a full recovery was made.
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Affiliation(s)
- Stefan Milosevic
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Centre of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (S.M.); (J.D.K.); (L.L.); (K.S.)
| | - Jelena Djokic Kovac
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Centre of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (S.M.); (J.D.K.); (L.L.); (K.S.)
- Department for Radiology, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia
| | - Ljubica Lazic
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Centre of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (S.M.); (J.D.K.); (L.L.); (K.S.)
| | - Milica Mitrovic
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Centre of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (S.M.); (J.D.K.); (L.L.); (K.S.)
- Department for Radiology, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia
| | - Katarina Stosic
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Centre of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (S.M.); (J.D.K.); (L.L.); (K.S.)
| | - Dragan Basaric
- Department for HBP Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, Koste Todorovica Street, No. 6, 11000 Belgrade, Serbia; (D.B.); (B.T.)
- Department for Surgery, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia; (N.I.); (O.S.)
| | - Boris Tadic
- Department for HBP Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, Koste Todorovica Street, No. 6, 11000 Belgrade, Serbia; (D.B.); (B.T.)
- Department for Surgery, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia; (N.I.); (O.S.)
| | - Stefan Stojkovic
- Clinic for Gastroenterology and Hepatology, University Clinical Centre of Serbia, Koste Todorovica Street, No. 2, 11000 Belgrade, Serbia;
| | - Slobodan Rasic
- Department of Stomach and Esophageal Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, Koste Todorovica Street No. 6, 11000 Belgrade, Serbia;
| | - Nenad Ivanovic
- Department for Surgery, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia; (N.I.); (O.S.)
- Department of Stomach and Esophageal Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, Koste Todorovica Street No. 6, 11000 Belgrade, Serbia;
| | - Ognjan Skrobic
- Department for Surgery, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia; (N.I.); (O.S.)
- Department of Stomach and Esophageal Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, Koste Todorovica Street No. 6, 11000 Belgrade, Serbia;
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Hulf T, Ben-David M. Small bowel obstruction caused by a mango phyto bezoar within a Meckel's diverticulum. J Surg Case Rep 2023; 2023:rjad613. [PMID: 37965537 PMCID: PMC10641289 DOI: 10.1093/jscr/rjad613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/15/2023] [Indexed: 11/16/2023] Open
Abstract
A fit and well gentleman in his 40s presented with vomiting and obstipation. His only relevant history being recent ingestion of a large quantity of mangoes. A computer tomography demonstrated a small bowel obstruction with a transition point in the right iliac fossa, but no other pathological findings. After a short period of non-operative management he proceeded to surgery, where a phytobezoar was identified at a Meckel's diverticulum causing a pantaloon shaped intra-luminal obstruction. A small bowel resection and primary anastomosis was performed and the patient had an uncomplicated post-operative course. Meckel's diverticuli are a relatively common phenomenon and may pre-dispose to bowel obstructions through a number of different mechanisms. This unusual case highlights the importance of considering this as a differential, and one that will likely require timely operative intervention.
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Affiliation(s)
- Toby Hulf
- Department of Surgery, Western Health, 160 Gordon Street, Footscray, VIC 3011, Australia
| | - Matan Ben-David
- Department of Surgery, Townsville University Hospital, 100 Angus Smith Dr, Douglas, QLD 4814, Australia
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Tetarbe S, Dirkhipa TY, Karkera PJ, Dennis PB, Shah I. Endoscopic Removal of a Recurrent Tricho bezoar in an Adolescent: A Case Report. JPGN Rep 2023; 4:e371. [PMID: 38034449 PMCID: PMC10684146 DOI: 10.1097/pg9.0000000000000371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 12/02/2023]
Abstract
Trichobezoar, a rare condition of intragastric hair accumulation is commonly associated with an underlying psychological condition. Removal of the bezoar either endoscopically or surgically (laparoscopy or laparotomy) with concurrent psychiatric assessment and treatment is the mode of treatment. We present a 10-year-old child with recurrent trichobezoar, who was managed surgically the first time, and subsequently endoscopic removal was done on recurrence of bezoar after 3 months. We also present the difficulties encountered during endoscopic bezoar removal.
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Affiliation(s)
- Shivangi Tetarbe
- From the Department of Pediatric Gastroenterology and Infectious Diseases
| | | | | | | | - Ira Shah
- Pediatric Infectious Diseases and Pediatric GI, B J Wadia Hospital for Children, Mumbai, India
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Korekawa K, Orikasa M, Kunimitsu A. Intestinal Obstruction Due to Reassembly after Endoscopic Crushing of a Bezoar. Intern Med 2023; 62:2965-2969. [PMID: 36889702 PMCID: PMC10641210 DOI: 10.2169/internalmedicine.1582-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/01/2023] [Indexed: 03/09/2023] Open
Abstract
An 87-year-old woman visited her primary-care doctor because of nausea and epigastric pain. Esophagogastroduodenoscopy (EGD) revealed a giant bezoar in her stomach. She was referred to our hospital after carbonated beverage dissolution proved ineffective and underwent endoscopic mechanical crushing. After crushing, the symptoms disappeared, and she began eating. Later, however, the crushed fragments reassembled in the duodenal bulb and caused intestinal obstruction. The patient underwent emergency EGD for crushing once more, and all of the fragments were extracted from the body. This case highlights the need for bezoars to be removed from the body after crushing in order to avoid reassembly.
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Affiliation(s)
- Kai Korekawa
- Department of Gastroenterology, Hachinohe City Hospital, Japan
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | | | - Atsushi Kunimitsu
- Department of Gastroenterology, Hachinohe City Hospital, Japan
- Department of Surgery, Tohoku University Graduate School of Medicine, Japan
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Gorgas E, Dowling S. Bezoar-induced small bowel obstruction: a rare cause of a common problem. J Surg Case Rep 2023; 2023:rjad553. [PMID: 37846418 PMCID: PMC10576991 DOI: 10.1093/jscr/rjad553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/21/2023] [Indexed: 10/18/2023] Open
Abstract
Small Bowel Obstruction (SBO) is one of the most common diagnoses that general surgeons encounter. Adhesive disease, hernia, and neoplasm are the most common causes. A more rare cause is bezoar. A 66-year-old female with a history of prior abdominal surgery presented with clinical concern for SBO. CT scan of the abdomen and pelvis demonstrated SBO with a transition point in the left lower abdomen. The patient failed nonoperative management and was taken to the operating room for exploration. On exploration, a segment of hemorrhagic jejunum was found with an intraluminal bezoar. SBO secondary to bezoar can be managed endoscopically or operatively depending on location and size of the stone. Operative intervention can vary between laparoscopic milking of the bezoar distally, enterotomy with stone extraction, or bowel resection and anastomosis. This case illustrates the importance of maintaining a broad differential for common surgical disease processes.
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Affiliation(s)
- Evan Gorgas
- Department of Trauma, Acute, and Critical Care Surgery, Trinity Health Ann Arbor, 5305 Elliot Drive Suite 2B10 Ypsilanti, MI 48197, United States
| | - Shawn Dowling
- Department of Trauma, Acute, and Critical Care Surgery, Trinity Health Ann Arbor, 5305 Elliot Drive Suite 2B10 Ypsilanti, MI 48197, United States
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Shah D, Ali Q, Bernier K, Gutierrez VA, Harper L. Successful Dissolution of a Large Gastric Phyto bezoar Through Nonsurgical and Nonendoscopic Fragmentation. ACG Case Rep J 2023; 10:e01141. [PMID: 37753104 PMCID: PMC10519568 DOI: 10.14309/crj.0000000000001141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 08/03/2023] [Indexed: 09/28/2023] Open
Abstract
A phytobezoar is the result of poorly digestible vegetable matter that accumulates in the gastrointestinal tract often forming a hard mass in the stomach. We present a case of a phytobezoar in a patient without predisposing risk factors, resulting in significant stomach distension initially believed to require high-risk surgical intervention but which ultimately resolved after 3 days of conservative treatment with prokinetic agents. The patient was discharged uneventfully and was recommended a low-fiber diet indefinitely while undergoing further workup for motility disorders.
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Affiliation(s)
- Divya Shah
- University of Arizona College of Medicine, Phoenix, AZ
| | - Qumber Ali
- University of Arizona College of Medicine, Phoenix, AZ
| | | | | | - Lise Harper
- University of Arizona College of Medicine, Phoenix, AZ
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Abreu da Silva A, Ricardo J, Ferreira A, Sousa D, Martins JA. Small Bowel Obstruction by a Phyto bezoar 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Ba-Shammakh SA, Al-Zughali EA, Al-Bustanji SM. When the Gut Tells a Story: Bezoars in a Neglected Autistic Child. Cureus 2023; 15:e44775. [PMID: 37809207 PMCID: PMC10557536 DOI: 10.7759/cureus.44775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
This case study delves into the unique presentation of bezoars in a 14-year-old autistic female who exhibited chronic diarrhea and abdominal pain. While trichobezoars, masses formed from ingested hair, are rare, they are predominantly seen in young females and are associated with psychiatric conditions. Through rigorous diagnostic procedures, including a computed tomography imaging of the abdomen and pelvis (CTAP) scan, fecal impaction, and multiple bezoars, including hair and non-biological items, were identified. The background revealed significant neglect, emphasizing the importance of a comprehensive approach that integrates medical, surgical, and psychosocial care.
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Lee KW, Ha YW, Lee JM, Choe JW, Hyun JJ, Lee HS. Minimally invasive treatment of duodenal obstruction with acute pancreatitis caused by two large bezoars. J Minim Access Surg 2023; 19:437-439. [PMID: 35915532 PMCID: PMC10449045 DOI: 10.4103/jmas.jmas_30_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/12/2022] [Indexed: 11/04/2022] Open
Abstract
Bezoar without gastrointestinal surgical history occurring simultaneously in the gastric and duodenal lumen is very rare. We report a case of acute pancreatitis due to duodenal obstruction caused by two large bezoars. Two large bezoars were detected in the gastric and duodenal lumen, respectively, on abdominal computed tomography (CT) scan and oesophagogastroduodenoscopy images. Bezoars were crushed and removed using endoscopic devices such as trapezoid basket and lithotripsy handle. After removal of bezoars, blood tests and CT follow-up tests confirmed improvement. In the case of bezoar, which causes duodenal obstruction, it is difficult to administer coke for dissolution, and if it is difficult to perform surgical approach due to old age, an endoscopic treatment using mechanical lithotripsy devices can be an alternative option.
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Affiliation(s)
- Kang Won Lee
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young Woo Ha
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae Min Lee
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jung Wan Choe
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jong Jin Hyun
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hong Sik Lee
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Korea University College of Medicine, Seoul, Republic of Korea
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Namikawa T, Utsunomiya M, Yokota K, Maeda H, Kitagawa H, Martins RN, Suganuma N, Kobayashi M, Hanazaki K, Seo S. Laparoscopic treatment for multiple huge diospyro bezoars in the stomach. Asian J Endosc Surg 2023. [PMID: 37095640 DOI: 10.1111/ases.13196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/13/2023] [Indexed: 04/26/2023]
Abstract
We report a case of a patient with multiple diospyrobezoars, a phytobezoar attributed to persimmons (Diospyros kaki) consumption, in the stomach, who was treated with laparoscopic complete surgical excision. A 76-year-old man with gastric phytobezoars presented to our hospital. Abdominal contrast-enhanced computed tomography revealed three well-defined, oval, nonhomogeneous masses with a mottled appearance in the stomach. Esophagogastroduodenoscopy revealed three large brown solid phytobezoars and gastric ulcers at the gastric angle. The clinical diagnosis was diospyrobezoar, and, due to the huge masses, the patient eventually underwent laparoscopic treatment when the medical and endoscopic approaches were unsuccessful. After gastrotomy in the anterior wall of the stomach, the phytobezoar was mobile inside the stomach, which was opened beside the gastric incision. The three phytobezoars were removed through the wound protector using sponge-holding forceps; the hole in the gastrotomy was closed in the mucosal and seromuscular layers with an intracorporeal suture technique. The weight and size of the phytobezoars were 140 g and 115 × 55 × 50 mm, 70 g and 55 × 45 × 35 mm, and 60 g and 50 × 40 × 35 mm, respectively. The patient was discharged on the 8th postoperative day without any complications. Laparoscopic surgery to extract bezoar is the treatment of choice for this rare entity, because it is a safe and effective approach.
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Affiliation(s)
- Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Nankoku, Kochi, Japan
| | | | - Keiichiro Yokota
- Department of Surgery, Kochi Medical School, Nankoku, Kochi, Japan
| | - Hiromichi Maeda
- Department of Surgery, Kochi Medical School, Nankoku, Kochi, Japan
| | | | | | - Narufumi Suganuma
- Department of Environmental Medicine, Kochi Medical School, Nankoku, Kochi, Japan
| | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Nankoku, Kochi, Japan
| | - Kazuhiro Hanazaki
- Integrated Center for Advanced Medical Technologies, Kochi Medical School Hospital, Nankoku, Kochi, Japan
| | - Satoru Seo
- Department of Surgery, Kochi Medical School, Nankoku, Kochi, Japan
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Vu R, Helmy M, Wong J. Bezoar in a periampullary duodenal diverticulum causing pancreaticobiliary obstruction and ascending cholangitis. Radiol Case Rep 2023; 18:1993-1996. [PMID: 36994219 PMCID: PMC10040452 DOI: 10.1016/j.radcr.2023.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 03/28/2023] Open
Abstract
Ascending cholangitis is a clinical syndrome characterized by fever, jaundice, and abdominal pain. It is caused by stasis and infection in the biliary tract with severity ranging from mild to life threatening. The most frequent causes of biliary obstruction and ascending cholangitis are choledocholithiasis, benign biliary stricture, and obstructing malignancy. In this report, we describe a rare case of a large periampullary duodenal diverticulum impacted with a food bezoar, causing pancreaticobiliary obstruction and ascending cholangitis.
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Affiliation(s)
- Ryan Vu
- Department of Biology, Stanford University, 450 Serra Mall, Stanford, CA 9430, USA
- Corresponding author.
| | - Mohammad Helmy
- Department of Radiology, University of California, Irvine, Irvine, CA 92697, USA
| | - James Wong
- Department of Radiology, Orange Coast Medical Center, 18111 Brookhurst St, Fountain Valley, CA 92708, USA
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McCarthy R, Coleman M. Recurrent intoxication due to clomipramine pharmaco bezoar. Anaesth Rep 2023; 11:e12230. [PMID: 37216042 PMCID: PMC10196812 DOI: 10.1002/anr3.12230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 05/24/2023] Open
Affiliation(s)
- R. McCarthy
- Departments of Anaesthesia and Intensive Care MedicineUniversity Hospital LimerickLimerickIreland
| | - M. Coleman
- Departments of Anaesthesia and Intensive Care MedicineUniversity Hospital LimerickLimerickIreland
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Dorterler ME, Günendi T, Çakmak M, Shermatova S. Bezoar types in children and aetiological factors affecting bezoar formation: A single-centre retrospective study. Afr J Paediatr Surg 2023; 20:8-11. [PMID: 36722563 PMCID: PMC10117012 DOI: 10.4103/ajps.ajps_70_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Bezoar is formed as a result of the accumulation of undigested food or foreign substances in the gastrointestinal tract (GIS). The present study aims to investigate the bezoar types seen in children and the aetiological factors involved in bezoar formation. METHODS A total of 16 patients who underwent an endoscopy and/or surgical treatment for bezoar at Harran University, Faculty of Medicine Pediatric Surgery Clinic between 2011 and 2019 were included in the study. The demographic information, laboratory and radiological findings were obtained from the patients' file records. RESULTS A total of ten patients (62.5%) were female with a mean age of 7.8 ± 4.9 years. Phytobezoars were detected in ten patients, trichobezoars in two patients, lactobezoar in one patient, and other types in three patients. The aetiological factors were determined to be congenital GIS anomaly in 6 (37.5%) patients; trichotillomania in 2 (12.5%) patients; mental retardation in 2 (12.5%) patients; ingestion of a foreign body during infancy in 2 (12.5%) patients; high intake of high-fibre fruit in 3 (18.5%) patients; and postoperative dysmotility in 2 (12.5%) patients. CONCLUSIONS Congenital GIS anomalies are mostly responsible for bezoar etiology in children and phytobezoar is the most common type of bezoar.
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Affiliation(s)
| | - Tansel Günendi
- Department of Pediatric Surgery, Harran University, Sanliurfa, Turkey
| | - Mehmet Çakmak
- Department of Pediatric Surgery, Harran University, Sanliurfa, Turkey
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Parker Cote JL, Gerber BT, Lee H, Miller SN, Meggs WJ. Failure of Computed Tomography (CT) in Detecting an Aspirin Pharmaco bezoar: A Case Report. Am J Case Rep 2022; 23:e936752. [PMID: 36536587 PMCID: PMC9790177 DOI: 10.12659/ajcr.936752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Prior studies suggest CT can identify bezoars under certain circumstances. Endoscopy provides diagnostic and therapeutic benefit in the setting of suspected aspirin bezoar. Does the absence of findings on CT scan exclude the presence of an aspirin bezoar? CASE REPORT A 64-year-old woman called the police and stated she ingested a bottle of aspirin to harm herself. Upon arrival to the Emergency Department, she was tachypneic with a GCS of 15. Initial laboratory results were: salicylate level of 1143 mcg/mL, respiratory alkalosis, bicarbonate of 9 meq/L, anion gap of 23, and normal renal function. Initial therapeutic intervention included infusions of glucose and bicarbonate, multiple doses of activated charcoal, intubation, and emergent hemodialysis. After hemodialysis, the salicylate level rebounded, and a Gastroenterology (GI) consultation was requested to rule out bezoar. On day 2, GI requested an abdominal CT scan with Gastrografin in place of endoscopy due to hemodynamic instability. A CT scan was negative for bezoar. After multiple hemodialysis sessions and whole-bowel irrigation with rebounding salicylate levels, GI was consulted again for reevaluation for endoscopy. On day 5, an endoscopy discovered a concretion containing pill fragments. Another endoscopy performed on day 7 removed further fragments. Salicylate levels began to consistently decline. Unfortunately, the patient's neurologic status did not improve, and on day 11 she was switched to palliative care and died. CONCLUSIONS Endoscopy with direct visualization is diagnostic and therapeutic in the setting of a possible bezoar. The absence of pharmacobezoar on imaging should not delay endoscopy in a clinical setting suggesting bezoar.
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Muacevic A, Adler JR, Parbhu S, Naraynsingh V. Small Bowel Obstruction Caused by an Aggressive Weight Loss Diet in a Patient With No Predisposing Factors. Cureus 2022; 14:e32594. [PMID: 36654594 PMCID: PMC9840865 DOI: 10.7759/cureus.32594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
Phytobezoars are a well-documented cause of small bowel obstruction. Previous reports include patients who have predisposing factors such as gastric surgery, diabetes mellitus, or poor dentition. Consequences of extreme dieting have also been reported, but a resultant phytobezoar and life-threatening bowel obstruction are rare. We present a case of phytobezoar solely due to a diet inordinately high in fiber.
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16
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Gierke H, Pfrommer T, Schäfer K, Weitschies W, Nolte T. Pharmaco bezoar Formation From HPMC-AS-Containing Spray-Dried Formulations in Nonclinical Safety Studies in Rats. Toxicol Pathol 2022; 50:920-929. [PMID: 36541591 DOI: 10.1177/01926233221145112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Changing the physical state from crystalline to amorphous is an elegant method to increase the bioavailability of poorly soluble new chemical entity (NCE) drug candidates. Subsequently, we report findings from repeat-dose toxicity studies of an NCE formulated as a spray-dried amorphous solid dispersion (SD-ASD) based on hydroxypropyl methylcellulose acetate succinate (HPMC-AS) in rats. At necropsy, agglomerates of SD-ASD were found in the stomach and small intestine, which in reference to literature were termed pharmacobezoars. We interpreted the pH-dependent insolubility of HPMC-AS in the acidic gastric environment to be a precondition for pharmacobezoar formation. Gastric pharmacobezoars were not associated with clinical signs or alterations of clinical pathology parameters. Pharmacobezoar-correlated histopathological findings were limited to the stomach and consisted of atrophy, erosion, ulcer, and inflammation, predominantly of the nonglandular mucosa. Pharmacobezoars in the small intestines induced obstructive ileus with overt clinical signs which required unscheduled euthanasia, prominent alterations of clinical pathology parameters indicative of hypotonic dehydration, degenerative and inflammatory processes in the gastrointestinal tract, and secondary renal findings. The incidence of pharmacobezoars increased with dose and duration of dosing. Besides the relevance of pharmacobezoars to animal welfare, they limit the non-observed adverse effect level in nonclinical testing programs and conclusively their informative value.
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Affiliation(s)
| | - Teresa Pfrommer
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Kerstin Schäfer
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | | | - Thomas Nolte
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
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17
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Gentile M, Vergara L, Schiavone V, Cestaro G, Sivero L. Harry Potter's Occlusion: Report of a Case of Pumpkin Seed Bezoar Rectal Impact. Front Surg 2022; 9:902701. [PMID: 35910475 PMCID: PMC9329672 DOI: 10.3389/fsurg.2022.902701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/17/2022] [Indexed: 11/25/2022] Open
Abstract
Bezoar is a term from Arabic "bāzahr" or ultimately from Middle Persian "p'tzhl" (pādzahr, "bezoar antidote" or less commonaly ægagropile or egagropile (2-4). It was believed to have the power of a universal antidote that works against any poison, and a glass containing a bezoar could neutralize any poison poured into it. In science, it is a mass of hair or undigested vegetable matter found in a human or animal intestines, similar to a hairball. Otherwise, the name could derive from a kind of Turkish goat whose name is just bezoar. Usually, it is found trapped in every part of the gastrointestinal system and must be distinguished by pseudobezoar, which is an nondigestible object voluntarily introduced into the digestive tract. The most common causes are a previous gastric surgery such as a gastric band (for weight loss) or gastric bypass, a reduced stomach acid (hypochlorhydria) or decreased stomach size, and a delayed gastric emptying, typically due to diabetes, autoimmune disorders, or mixed connective tissue disease. Seed bezoars are usually found in the rectum of patients without predisposing factors, causing constipation and pain. Rectal impaction is common after ingestion of seeds, while a true occlusion is rare. Although several cases of phytobezoars composed of various types of seeds are reported in the literature, bezoars of pumpkin seeds have rarely been reported. The authors report a case of fecal impaction by pumpkin seed bezoars with abdominal pain: a difficulty to void with subsequent rectal inflammation and hemorrhoid enlargement was observed. The patient underwent a successful manual disimpaction.
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Affiliation(s)
- Maurizio Gentile
- Department of General Surgery, Endocrinology, Orthopedics and Rehabilitation, Federico II University of Naples, Naples, Italy
| | - Lorenzo Vergara
- Department of General Surgery, Endocrinology, Orthopedics and Rehabilitation, Federico II University of Naples, Naples, Italy
| | - Vincenzo Schiavone
- Department of General Surgery, Endocrinology, Orthopedics and Rehabilitation, Federico II University of Naples, Naples, Italy
| | | | - Luigi Sivero
- Department of Medicine and Surgery for Digestive Tract Diseases, Federico II University of Naples, Naples, Italy
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18
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Gallagher KC, Pinzon-Guzman C, Pierce RA, Tan MCB. Small Bowel Obstruction Caused by Bezoar Formation Around Intraluminal Hernia Mesh. Am Surg 2022; 88:1904-1906. [PMID: 35451332 DOI: 10.1177/00031348221086788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present a case report wherein a 55-year-old female presented to our clinic with chronic nausea, vomiting, and dehydration in the setting of a complex past surgical history, including laparoscopic incisional hernia repair in 2007 with intraperitoneal TiMeshTM. She then developed chronic nausea and vomiting and was hospitalized numerous times for dehydration. Due to her ongoing symptoms, she was taken to the operating room for exploration. A large, firm, mobile mass was identified within a loop of small bowel and was found to be a large bezoar firmly attached to a piece of intraluminal mesh. She progressed well postoperatively and, on outpatient follow-up, her pre-operative abdominal symptoms had completely resolved. To our knowledge, this is the first reported case of gallstone-like bezoar formation around an intraluminal hernia mesh causing small bowel obstruction and chronic abdominal pain.
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Affiliation(s)
- Kathleen C Gallagher
- Section of Surgical Sciences, 5718Vanderbilt University Medical Center, Nashville, TN, USA
| | - Carolina Pinzon-Guzman
- Section of Surgical Sciences, 5718Vanderbilt University Medical Center, Nashville, TN, USA
| | - Richard A Pierce
- Section of Surgical Sciences, 5718Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marcus C B Tan
- Section of Surgical Sciences, 5718Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Ingram Cancer Center, 12328Vanderbilt University Medical Center, Nashville, TN, USA
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19
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Delimpaltadaki DG, Gkionis IG, Flamourakis ME, Strehle AF, Bachlitzanakis EN, Giakoumakis MI, Christodoulakis MS, Spiridakis KG. A rare giant gastric tricho bezoar 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] [What about the content of this article? (0)] [Affiliation(s)] [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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20
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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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21
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Armstrong DG, Kaul I, Hernandez JA, Chumpitazi BP. Gastrojejunal Enteral Tube Serving as a Small Bowel Bezoar Nidus. Cureus 2021; 13:e15266. [PMID: 34221745 PMCID: PMC8237910 DOI: 10.7759/cureus.15266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Gastrojejunal (GJ) tube placement is indicated in the management of gastric feeding-related intolerance. Though uncommon, GJ complications may occur. We present the case of a five-year-old male with congenital heart disease in which image-guided replacement of a GJ tube was unable to be completed due to a mass adhered to the tip of the tube. The subsequent endoscopic evaluation identified the mass as a hair-based bezoar and the tube was successfully removed. The child was subsequently diagnosed with trichotillomania, trichophagia, and pica. This case illustrates the importance of recognizing bezoar formation as a potential complication of GJ enteric tubes, particularly in children with trichophagia and pica.
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Affiliation(s)
| | - Isha Kaul
- Department of Pediatrics, Section of Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, Houston, USA.,Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Houston, USA
| | - Jose A Hernandez
- Department of Radiology, Baylor College of Medicine, Houston, USA.,Division of Interventional Radiology, Texas Children's Hospital, Houston, USA
| | - Bruno P Chumpitazi
- Department of Pediatrics, Section of Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, Houston, USA.,Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Houston, USA.,Department of Agriculture Research Service, Children's Nutrition Research Center, Houston, USA
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22
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Samuel S, Sharko A, Shrestha J, Sherchan R, Baig S. A Rare Case of Small Bowel Obstruction Due to Sunflower Seeds Consumption in an Adult. Cureus 2021; 13:e14330. [PMID: 33968538 PMCID: PMC8101512 DOI: 10.7759/cureus.14330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Small bowel obstruction can occur due to multiple etiologies, including intra-abdominal adhesions, hernias, strictures, Crohn's disease, and malignancies. An infrequent cause of small bowel obstruction can be seed bezoars. We present a case of a 72-year-old male who presented to the emergency department with a clinical picture of small bowel obstruction without any apparent risk factors for this condition. After thorough questioning, it was revealed that he had consumed a large number of sunflower seeds prior to the onset of symptoms. This eventually was proved to be the cause of his symptoms. The case is presented with the intent to highlight the necessity of acquiring dietary history in patients with high suspicion for bowel obstruction without any predisposing risk factors.
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Affiliation(s)
- Shirly Samuel
- Internal Medicine, Northwestern Medicine McHenry Hospital, Rosalind Franklin University of Medicine and Science, McHenry, USA
| | - Artem Sharko
- Internal Medicine, Northwestern Medicine McHenry Hospital, Rosalind Franklin University of Medicine and Science, McHenry, USA
| | - Jishna Shrestha
- Internal Medicine, Northwestern Medicine McHenry Hospital, Rosalind Franklin University of Medicine and Science, McHenry, USA
| | - Robin Sherchan
- Internal Medicine, Northwestern Medicine McHenry Hospital, Rosalind Franklin University of Medicine and Science, McHenry, USA
| | - Shaji Baig
- Internal Medicine, Northwestern Medicine McHenry Hospital, Rosalind Franklin University of Medicine and Science, McHenry, USA
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23
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Mathew RP, Sarasamma S, Jose M, Toms A, Jayaram V, Patel V, Low G. Clinical presentation, diagnosis and management of aerodigestive tract foreign bodies in the adult population: Part 1. SA J Radiol 2021; 25:2022. [PMID: 33936794 PMCID: PMC8063768 DOI: 10.4102/sajr.v25i1.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/14/2020] [Indexed: 12/11/2022] Open
Abstract
In the adult population, foreign bodies may be accidentally or intentionally ingested or even inserted into a body cavity. The majority of accidentally ingested foreign bodies pass through the alimentary tract without any complications and rarely require intervention. Accidentally ingested foreign bodies are usually fish bones, bones of other animals, and dentures. Oesophageal food impaction is the commonest cause of oesophageal foreign bodies in the Western hemisphere. Intentionally ingested foreign bodies may be organic or inorganic, and often require intervention; these patients have either underlying psychological or mental disease or are involved in illegal activities such as body packing, which involves trafficking narcotics. Imaging plays a crucial role in not only identifying the type, number and location of the foreign body but also in excluding any complications. In this comprehensive pictorial review, we provide an overview of the spectrum of foreign bodies ingested in adults, emphasising the role of various imaging modalities, their limitations and common foreign body mimickers on imaging.
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Affiliation(s)
- Rishi P Mathew
- Department of Radiology, Faculty of Radiology, Rajagiri Hospital, Aluva, India
| | - Sreekutty Sarasamma
- Department of Radiology, Faculty of Radiology, Rajagiri Hospital, Aluva, India
| | - Merin Jose
- Department of Radiology, Faculty of Radiology, Rajagiri Hospital, Aluva, India
| | - Ajith Toms
- Department of Radiology, Faculty of Radiology, Rajagiri Hospital, Aluva, India
| | - Vinayak Jayaram
- Department of Radiology, Faculty of Radiology, Rajagiri Hospital, Aluva, India
| | - Vimal Patel
- Department of Radiology & Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Canada
| | - Gavin Low
- Department of Radiology & Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Canada
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24
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Wilson JM, Wallace CK, Brice AK, Makaron L. Mineralized Tricho bezoars in a Rhesus Macaque (Macaca mulatta). J Med Primatol 2020; 49:158-161. [PMID: 32100304 DOI: 10.1111/jmp.12466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/05/2020] [Accepted: 02/08/2020] [Indexed: 11/26/2022]
Abstract
A five-year-old female rhesus macaque (Macaca mulatta) presented with a thin body condition and multiple palpable mid-abdominal masses. Mineralized cecal trichobezoars were removed surgically. Thirteen months later, similar masses recurred and were confirmed with radiographs. This is the first case report of a mineralized cecal trichobezoar in a rhesus macaque.
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Affiliation(s)
- Jolaine M Wilson
- Laboratory Animal Services, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Chelsea K Wallace
- University Laboratory Animal Resources, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Angela K Brice
- University Laboratory Animal Resources, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Leah Makaron
- Gene Therapy Program, University of Pennsylvania, Philadelphia, Pennsylvania
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25
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Kwok AMF. Tricho bezoar as a cause of pediatric acute small bowel obstruction. Clin Case Rep 2020; 8:166-170. [PMID: 31998509 PMCID: PMC6982476 DOI: 10.1002/ccr3.2576] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/28/2019] [Accepted: 11/05/2019] [Indexed: 01/24/2023] Open
Abstract
This case serves to raise awareness of trichobezoar as a diagnosis in young children who present with abdominal pain, a palpable mass, and signs of acute small bowel obstruction.
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26
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Abstract
A 60-year-old man presented with abdominal pain. He was later diagnosed on imaging to have high-grade small bowel obstruction. The patient underwent surgery, and a hard, rounded bezoar resembling the endosperm of Nypa fruticans, colloquially known as attap chee, was found at the point of obstruction. Small bowel obstruction is a common acute surgical condition with multiple causes, including bezoars. We discuss the typical imaging features of bezoars causing small bowel obstruction as well as potential pitfalls that can mimic the appearance of a bezoar.
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Affiliation(s)
| | - Hsien Min Low
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
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27
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Affiliation(s)
| | - Maria-Grazia Scarpa
- Department of Surgery, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Federico Poropat
- Department of Pediatrics, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Rita Giorgi
- Department of Pediatrics, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Flora Maria Murru
- Department of Radiology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Egidio Barbi
- University of Trieste, Trieste, Italy.,Department of Pediatrics, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
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28
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Darwish AA, Abdelgawad AE, Platt E, Garrett-Cox R. Formation of a temporary gastrostomy to aid delivery of gastric tricho bezoar and decrease incidence of wound infection. BMJ Case Rep 2019; 12:12/6/e228660. [PMID: 31229972 DOI: 10.1136/bcr-2018-228660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Trichobezoars are relatively uncommon problems with a known female predominance. We report two female children with gastric bezoars. Main presenting symptoms were abdominal distension, weight loss and anaemia. Upper abdominal mass was palpable in both. Diagnosis was suspected on initial abdominal radiograph and ultrasound scan then confirmed by upper endoscopy. No bowel extension was recorded in either case. We report here a modification of the surgical technique in which the gastrostomy cut edges were anchored to the laparotomy skin. This modification aided easy and complete delivery of hair balls avoiding any spillage or wound contamination.
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Affiliation(s)
| | | | - Esther Platt
- Paediatric Surgery Department, Bristol Royal Hospital for Children, Bristol, UK
| | - Robin Garrett-Cox
- Paediatric Surgery Department, Bristol Royal Hospital for Children, Bristol, UK
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29
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Abstract
Seed bezoars are a distinct subcategory of phytobezoars, caused by indigestible vegetable or fruit seeds. The aim of our study was to present a comprehensive review on seed bezoars, focusing on epidemiology, symptomatology, diagnosis and treatment options. A systematic review of the English literature (1980-2018) was conducted, using PubMed, Embase and Google Scholar databases. Fifty-two studies fulfilled the inclusion criteria, with a total of 153 patients, the majority of whom (72%) came from countries around the Eastern Mediterranean and the Middle East. Patients complained primarily about constipation (63%), abdominal/rectal pain (19%) or intestinal obstruction (17%). Most seed bezoars were found in the rectum (78%) and the terminal ileum (16%). Risk factors were recognised in 12% of cases. Manual disimpaction under general anaesthesia was the procedure of choice in 69%, while surgery was required in 22% of cases. Seed bezoars appear to represent a different pathophysiological process compared to fibre bezoars. Seeds usually pass through the pylorus and ileocaecal valve, due to their small size, and accumulate gradually in the colon. Seed bezoars are usually found in the rectum of patients without predisposing factors, causing constipation and pain. History and digital rectal examination are the mainstay of diagnosis, with manual extraction under general anaesthesia being the procedure of choice.
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30
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Malberg JA, Hespel AM. Small intestinal enterolith in a dog presenting for a suspected gastric foreign body. Vet Radiol Ultrasound 2019; 62:E26-E29. [PMID: 31037785 DOI: 10.1111/vru.12758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/15/2019] [Accepted: 02/17/2019] [Indexed: 11/30/2022] Open
Abstract
A 12-year-old Labrador Retriever presented for an acute onset of anorexia and vomiting. Abdominal ultrasound and abdominal radiographs were performed, and on the latter a large mineral opaque structure with concentric rings within the cranial abdomen was diagnosed as a gastric foreign body. Laparotomy revealed that the suspected gastric foreign body was a large enterolith within the small intestines. Enteroliths should be considered as one of the differential diagnoses for a large mineralized abdominal structure in a dog presented for gastrointestinal clinical signs.
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Affiliation(s)
- Jessica A Malberg
- Department of Surgical Sciences, University of Wisconsin Veterinary Teaching Hospital, Madison, Wisconsin
| | - Adrien-Maxence Hespel
- Department of Surgical Sciences, University of Wisconsin Veterinary Teaching Hospital, Madison, Wisconsin
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31
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Ahmed M, Habis S, Mahmoud A, Saeed R, Elkahly M. Surgical Removal of Numerous Foreign Body Gastric Bezoar: A Case Report. Cureus 2019; 11:e4173. [PMID: 31093472 PMCID: PMC6502284 DOI: 10.7759/cureus.4173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A 53-year-old mentally retarded male was brought to our emergency room after vomiting a plastic glove. Computed tomography revealed marked gastric distention containing large amount of residual food debris. Endoscopic retrieval was unsuccessful. Surgical removal of the foreign bodies was done. The patient did well and was discharged from the hospital.
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Affiliation(s)
- Mohamed Ahmed
- Surgery, Riverside Community Hospital, Riverside, USA
| | - Saba Habis
- Internal Medicine, Riverside Community Hospital, Riverside, USA
| | - Ahmed Mahmoud
- Surgery, Riverside Community Hospital, Riverside, USA
| | - Rasha Saeed
- Surgery, Riverside Community Hospital, Riverside, USA
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32
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Rainer F, Prenner G, Binder LP, Fickert P, Plank J. Case of nasogastric tube dysfunction. Gut 2019; 68:206-262. [PMID: 29305431 DOI: 10.1136/gutjnl-2017-315619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/11/2017] [Accepted: 12/14/2017] [Indexed: 12/08/2022]
Abstract
CLINICAL PRESENTATION An elderly female patient was admitted to intensive care for prolonged vasopressor therapy and mechanical ventilation after cardiac arrest and acute percutaneous coronary intervention. Antiplatelet, thyroid hormone replacement and statin therapies were administered through a 14-French nasogastric tube (Nestlé Health Science) and enteral feeding was initiated. Correct position of the nasogastric tube was confirmed radiologically. On the seventh day in the intensive care, our patient was seen to regurgitate soft crumbs into her mouth. The blocked nasogastric tube was removed, but attempts to reinsert another tube failed.Upper GI endoscopy revealed an obstruction of the oesophagus with a milky-yellowish caseous substance 20 cm from the incisors (figure 1). The proximal part of the mass showed a central hole and ring-shaped layers resembling the cut face of a tree trunk.gutjnl;68/2/206/F1F1F1Figure 1Obstruction of the oesophagus with a milky-yellowish caseous substance. QUESTIONS What caused the obstruction?How should we manage such a problem?
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Affiliation(s)
- Florian Rainer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Styria, Austria
| | - Guenther Prenner
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Styria, Austria
| | - Lukas Peter Binder
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Styria, Austria
| | - Peter Fickert
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Styria, Austria
| | - Johannes Plank
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Styria, Austria
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33
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Doležalová Kormanová K, Fried M. Unusual complications after bariatric surgery gastric plication. Rozhl Chir 2019; 98:77-80. [PMID: 30897916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Laparoscopic gastric plication (LGCP) is a relatively new bariatric-metabolic operation. The greater gastric curvature is invaginated into the gastric lumen, resulting in a shape similar to that obtained after sleeve gastrectomy. In our paper, we report two interesting cases of patients with gastric plication who presented specific findings - food bezoar and gastric diverticulum. Case reports of bezoars after bariatric surgery are reported most commonly after gastric banding and gastric bypass surgery. Diverticulum of the gastric wall is a complication specific to LGCP when a part of the invaginated gastric wall is slipped between two sutures. A prompt endoscopic intervention is recommended to relieve the obstruction and, in case of diverticulum, to diagnose and manage it surgically.
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34
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Abstract
A 75-year-old Japanese woman presented with nausea and appetite loss. Computed tomography showed a radiopaque substance in the stomach. Esophagogastroduodenoscopy revealed bezoars in the stomach, which were endoscopically retrieved. The bezoars were mainly composed of magnesium and oxide. Although bezoar formation associated with magnesium oxide consumption is infrequently encountered, the present case indicates that pharmacobezoar should be considered among the differential diagnoses in patients who demonstrate a radiopaque mass in the digestive tract and have a history of magnesium oxide use.
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Affiliation(s)
- Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Shunsuke Saito
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
| | - Masao Yoshioka
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
| | - Haruo Urata
- Central Research Laboratory, Okayama University Medical School, Japan
| | - Kumiko Ueda
- Department of Pharmacy, Okayama University Hospital, Japan
| | - Kazuhide Yamamoto
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
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35
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Affiliation(s)
- Hao Xiang
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Jason Han
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | | | - Lloyd J Ridley
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,Medical Imaging, University of Sydney, Sydney, New South Wales, Australia
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36
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Mazine K, Barsotti P, Elbouhaddouti H, Mouaqit O, Benjelloun E, Taleb KA, Ousadden A. [Gastroduodenal tricho bezoar: about a case]. Pan Afr Med J 2018; 30:25. [PMID: 30167052 PMCID: PMC6110540 DOI: 10.11604/pamj.2018.30.25.12239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 04/21/2018] [Indexed: 11/12/2022] Open
Abstract
Le trichobézoard gastroduodénal est une affection rare, dont le diagnostic est facile en présence d'un contexte évocateur. Nous rapportons le cas d'une jeune patiente âgée de 21 ans suivie pour une schizophrénie, admise pour douleur abdominale aiguë, vomissements et masse épigastrique, le scanner abdominal a permis de faire suspecter un bézoard en objectivant des lésions hétérogènes occupant tout l'estomac, ne prenant pas le contraste et semblant indépendante de la paroi gastrique. Un traitement chirurgical a été réalisé avec exérèse du trichobézoard par gastrotomie, sans complications et un transfert en service de psychiatrie.
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Affiliation(s)
- Khalid Mazine
- Université Sidi Mohamed Ben Abdellah, Service de Chirurgie Viscérale A (C3), CHU Hassan II Fes, Maroc
| | - Pierre Barsotti
- Service de Chirurgie Generale Digestive et Endocrine Hôpital Emile Müller Mulhouse, France
| | - Hicham Elbouhaddouti
- Université Sidi Mohamed Ben Abdellah, Service de Chirurgie Viscérale A (C3), CHU Hassan II Fes, Maroc
| | - Ouadii Mouaqit
- Université Sidi Mohamed Ben Abdellah, Service de Chirurgie Viscérale A (C3), CHU Hassan II Fes, Maroc
| | - Elbachir Benjelloun
- Université Sidi Mohamed Ben Abdellah, Service de Chirurgie Viscérale A (C3), CHU Hassan II Fes, Maroc
| | - Khalid Ait Taleb
- Université Sidi Mohamed Ben Abdellah, Service de Chirurgie Viscérale A (C3), CHU Hassan II Fes, Maroc
| | - Abdelmalek Ousadden
- Université Sidi Mohamed Ben Abdellah, Service de Chirurgie Viscérale A (C3), CHU Hassan II Fes, Maroc
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Abstract
A bezoar is a collection of packed indigestible matter that accumulates in the gastrointestinal tract after ingestion by the patient. It may be made of hair (trichobezoar), vegetable or fruit (phytobezoar), or other indigestible materials. Trichobezoars are thought to form due to hair’s natural enduring nature, as they get matted and stick together in the gut. We present the case of a young female who was 16-weeks pregnant with twins presenting to the general surgery clinic with abdominal pain, vomiting and a palpable abdominal mass, which eventually turned out to be a massive trichobezoar manifesting as Rapunzel syndrome. Rapunzel syndrome is a large trichobezoar extending from the stomach into the small intestine. This is perhaps the first reported case of Rapunzel syndrome in a patient pregnant with twins.
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Affiliation(s)
- Mohammad Ali Shahab
- Department of Internal Medicine, Louis A. Weiss Memorial Hospital, Chicago, USA
| | - Ahmed Shahab
- Department of Internal Medicine, Louis A. Weiss Memorial Hospital, Chicago, USA
| | - Shahab Javid
- Department of Urology, Liaquat National Hospital, Karachi, PAK
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Bustos R, Gheza F, Masrur M. Snapshot in surgery: How do you approach this 12-year-old girl? Clin Case Rep 2018; 6:1389-1390. [PMID: 29988600 PMCID: PMC6028356 DOI: 10.1002/ccr3.1614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/19/2018] [Accepted: 05/03/2018] [Indexed: 11/11/2022] Open
Abstract
This case open questions about the dimensional limit for a laparoscopic treatment of a giant bezoar. A minimally invasive option should be considered every time a gastric obstruction is suspected, particularly for psychiatric patients, for whom a short hospital stay can be greatly beneficial.
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Affiliation(s)
- Roberto Bustos
- Division of General, Minimally Invasive and Robotic SurgeryDepartment of SurgeryUniversity of Illinois at ChicagoChicagoILUSA
| | - Federico Gheza
- Division of General, Minimally Invasive and Robotic SurgeryDepartment of SurgeryUniversity of Illinois at ChicagoChicagoILUSA
| | - Mario Masrur
- Division of General, Minimally Invasive and Robotic SurgeryDepartment of SurgeryUniversity of Illinois at ChicagoChicagoILUSA
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Dokoupil M, Marecová K, Handlos P, Březina P. Death of a Female Prostitute Due to Intestinal Obstruction by an Unknown Substance. J Forensic Sci 2018; 64:289-291. [PMID: 29768663 DOI: 10.1111/1556-4029.13824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/25/2018] [Accepted: 04/27/2018] [Indexed: 11/28/2022]
Abstract
A young adult black female, known to be a prostitute and suspected of smuggling narcotics, was found dead in her apartment in a state of early decomposition. Oval-shaped gray-white masses of exogenous origin protruded from the anus. The autopsy showed dilatation of the folds of the large intestine, which were almost completely filled with these oval-shaped gray-white masses of foreign material. The uterus was enlarged with multiple large leiomyomas. Toxicological tests of blood and the foreign material revealed no toxicologically relevant substances. Kaolin was detected in a sample of the foreign material from the large intestine. The immediate cause of death was intestinal obstruction due to the formation of a kaolin bezoar with simultaneous compression of the large intestine by the enlarged myomatous uterus. Subsequent revelation of a habit the deceased had brought from her native country led to the conclusion that this exotic custom was responsible for her death.
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Affiliation(s)
- Marek Dokoupil
- Department of Forensic Medicine, University Hospital Ostrava, CZ-708 52, Ostrava, Czech Republic.,Department of Epidemiology and Public Health, Faculty of Medicine, Ostrava University, CZ-703 00, Ostrava, Czech Republic
| | - Klára Marecová
- Department of Forensic Medicine and Medical Law, University Hospital Olomouc, CZ-779 00, Olomouc, Czech Republic
| | - Petr Handlos
- Department of Forensic Medicine, University Hospital Ostrava, CZ-708 52, Ostrava, Czech Republic.,Department of Intensive Medicine and Forensic Studies, Faculty of Medicine, Ostrava University, CZ-703 00, Ostrava, Czech Republic
| | - Petr Březina
- Department of Epidemiology and Public Health, Faculty of Medicine, Ostrava University, CZ-703 00, Ostrava, Czech Republic.,Department of Forensic Techniques and Expertise, The Regional Policy Of The Moravian - Silesian Region, CZ-702 00, Ostrava, Czech Republic
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40
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Horesh N, Rosin D, Dreznik Y, Amiel I, Jacoby H, Nadler R, Gutman M, Klang E. A Single Tertiary Center 10-Year Experience in the Surgical Management of Gastrointestinal Bezoars. J Laparoendosc Adv Surg Tech A 2018; 28:967-971. [PMID: 29641363 DOI: 10.1089/lap.2017.0752] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Gastrointestinal (GI) bezoars are the most common foreign bodies causing obstruction in the GI tract. They are frequently seen following upper GI tract surgery and surgical intervention is required often. The aim of this study is to describe the surgical management of GI bezoars. MATERIALS AND METHODS A retrospective cohort study, including all patients diagnosed with bezoars between May 2008 and May 2017, was conducted. Patient charts were reviewed, and demographics, clinical, surgical, and postoperative data were collected and analyzed. RESULTS Forty-five patients were included, with a mean age of 62.04 years (Range 18-91). Thirty patients underwent previous surgery (66.6%), most commonly surgical interventions for peptic ulcer disease (22 patients, 73.3%). Obstruction was most common in the ileum (27 patients, 60%). Thirty-nine patients (86.7%) required surgical intervention. Laparoscopy was attempted in 20 patients (51.2%), but conversion to open procedure was required in 11 patients (55%). Postoperative complication rate was 41%. No preoperative factors were found to be correlated with postoperative complications. Postoperative complications were associated with a longer length of stay (P = .006) and a higher readmission rate (P = .04). Patients treated with laparoscopy tended to have a lower BMI (P = .04), less previous surgeries (P = .04), and a bezoar located more proximally (P = .03), however, laparoscopy showed no benefit in complications rate, readmissions, and length of stay. CONCLUSIONS GI bezoars require surgical intervention at high rates. Postoperative complications are common. Completion of an upper GI endoscopy is important and should be performed at an early stage of management.
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Affiliation(s)
- Nir Horesh
- 1 Department of General Surgery and Transplantations, Tel Aviv University , Ramat Gan, Israel
| | - Danny Rosin
- 1 Department of General Surgery and Transplantations, Tel Aviv University , Ramat Gan, Israel
| | - Yael Dreznik
- 1 Department of General Surgery and Transplantations, Tel Aviv University , Ramat Gan, Israel
| | - Imri Amiel
- 1 Department of General Surgery and Transplantations, Tel Aviv University , Ramat Gan, Israel
| | - Harel Jacoby
- 1 Department of General Surgery and Transplantations, Tel Aviv University , Ramat Gan, Israel
| | - Roy Nadler
- 1 Department of General Surgery and Transplantations, Tel Aviv University , Ramat Gan, Israel
| | - Mordechai Gutman
- 1 Department of General Surgery and Transplantations, Tel Aviv University , Ramat Gan, Israel
| | - Eyal Klang
- 2 Department of Radiology, Chaim Sheba Medical Center, affiliated with The Faculty of Medicine, Tel Aviv University , Ramat Gan, Israel
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Iwamuro M, Tanaka S, Moritou Y, Inaba T, Higashi R, Kusumoto C, Yunoki N, Ishikawa S, Okamoto Y, Kawai Y, Kitada KI, Takenaka R, Toyokawa T, Okada H. Importance of Second-look Endoscopy on an Empty Stomach for Finding Gastric Bezoars in Patients with Gastric Ulcers. Acta Med Okayama 2018; 71:241-247. [PMID: 28655944 DOI: 10.18926/amo/55207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Most gastric bezoars can be treated with endoscopic fragmentation combined with or without cola dissolution, whereas laparotomy or laparoscopic surgery is generally inevitable for small intestinal bezoars because they cause small bowel obstruction. Therefore, early diagnosis and management of gastric bezoars are necessary to prevent bezoar-induced ileus. To investigate the incidence of overlooked gastric bezoars during the initial esophagogastroduodenoscopy, we retrospectively reviewed the cases of 27 patients diagnosed with gastrointestinal bezoars. The bezoars were diagnosed using esophagogastroduodenoscopy (n=25), abdominal ultrasonography (n=1), and barium follow-through examination (n=1). Bezoars were overlooked in 9/25 patients (36.0%) during the initial endoscopy examination because the bezoars were covered with debris in the stomach. Of the 9 patients, 8 had concomitant gastric ulcers, and the other patient had gastric lymphoma. Although a computed tomography (CT) scan was performed before the second-look endoscopy in 8 of the 9 patients, the bezoars were mistaken as food debris on CT findings and were overlooked in these patients. In conclusion, gastric bezoars may not be discovered during the initial esophagogastroduodenoscopy and CT scan. In cases with debris in the stomach, second-look endoscopy is essential to detect bezoars.
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Affiliation(s)
- Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558,
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42
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Abstract
A 13-year-old female was presented to the emergency department following an intentional ingestion. The patient developed significant toxicity including multiple, discreet tonic-clonic seizures. Despite appropriate resuscitation and antidotal management, the patient's symptoms persisted for more than 36 hours post-ingestion. An upright abdominal radiograph was performed revealing a radiopacity suggesting a pharmacobezoar. An esophagogastroduodenoscopy was performed with successful removal of a tennis ball-sized pharmacobezoar. The patient's symptoms subsequently subsided and she recovered fully with no neurologic deficits. Diphenhydramine has not been previously identified as a medication likely to form a pharmacobezoar and has not been shown to be radiopaque. Though bezoar formation is a rare clinical scenario, it is one that toxicologists must consider in patients with clinical courses that persist far beyond expected based on known toxicokinetic principles.
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Affiliation(s)
- Jami Johnson
- a Oklahoma Center for Poison and Drug Information, University of Oklahoma College of Pharmacy , Oklahoma City , OK , USA
| | - Kristie Williams
- a Oklahoma Center for Poison and Drug Information, University of Oklahoma College of Pharmacy , Oklahoma City , OK , USA
| | - William Banner
- a Oklahoma Center for Poison and Drug Information, University of Oklahoma College of Pharmacy , Oklahoma City , OK , USA.,b Pediatric Services, Pediatric Critical Care and Toxicology , Integris Baptist Medical Center , Oklahoma City , OK , USA
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43
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Pedrolli C, Sacchi MC, Togni M, Cereda E. A case of hyperemesis in bulimia nervosa. Int J Eat Disord 2015; 48:446-8. [PMID: 24902945 DOI: 10.1002/eat.22315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 05/06/2014] [Accepted: 05/25/2014] [Indexed: 11/06/2022]
Abstract
Bulimia nervosa is an eating disorder defined by recurrent episodes of binge eating followed by compensatory behaviors, primarily self-induced vomiting. Most common complications are due to purge behaviors and are frequently responsible for hospitalization. These include electrolyte disturbances, dehydration, hypovolemia, stomatitis, esophageal diseases, and functional impairment of the colon. However, an obstruction-like syndrome has never been reported. We report the case of a middle-age woman suffering from bulimia nervosa and referring at the emergency department with a 7-day story of hyperemesis responsible for an acute renal failure. During hospitalization, after the most important and common medical causes of hyperemesis were excluded, an upper gastrointestinal endoscopy was performed. The endoscopist reported the presence of an impressive bezoar, which underwent to mechanical fragmentation and biopsy sampling, revealing it was made up exclusively of liquorice wheels. An endoscopy performed few days after showed the complete dissolution of the bezoar, and the patient was discharged without any further gastrointestinal complaint.
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Affiliation(s)
- Carlo Pedrolli
- Dietetic and Clinical Nutrition Unit, "Santa Chiara" Hospital, APSS Trento, Trento, Italy
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44
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Abstract
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.
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Affiliation(s)
- Xian-Rui Wu
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jean Ashburn
- Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, USA
| | - Bo Shen
- Department of Gastroenterology/Hepatology, The Cleveland Clinic Foundation, Cleveland, USA
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45
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Abstract
La dysphagie est un signe sémiologique peu fréquent chez l'enfant, dont l'oesophagite est souvent la cause. Les auteurs rapportent une cause rare de dysphagie chez une enfant de 3 ans et demi, ayant évolué 5 mois avant son admission et chez qui l'exploration para clinique a conclu à un bézoard. L'endoscopie a permis une extraction totale. À travers ce cas, nous essayons de rappeler aux praticiens les particularités cliniques de cette affection, ainsi que celles de la prise en charge et le suivi.
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Affiliation(s)
- Yousra El Boussaadni
- Université Mohamed Premier, CHU Mohamed VI, Département de Pédiatrie, Hopital Al Farabi, Oujda, Maroc
| | - Sahare El Mahjoubi
- Université Mohamed Premier, CHU Mohamed VI, Département de Gastroenterologie, Hopital Al Farabi, Oujda, Maroc
| | - Aziza El Ouali
- Université Mohamed Premier, CHU Mohamed VI, Département de Pédiatrie, Hopital Al Farabi, Oujda, Maroc
| | - Wafaa Khannoussi
- Université Mohamed Premier, CHU Mohamed VI, Département de Gastroenterologie, Hopital Al Farabi, Oujda, Maroc
| | - Noufissa Benajiba
- Université Mohamed Premier, CHU Mohamed VI, Département de Pédiatrie, Hopital Al Farabi, Oujda, Maroc
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46
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Al-Janabi IS, Al-Sharbaty MA, Al-Sharbati MM, Al-Sharifi LA, Ouhtit A. Unusual tricho bezoar of the stomach and the intestine: a case report. J Med Case Rep 2014; 8:79. [PMID: 24580892 PMCID: PMC3946194 DOI: 10.1186/1752-1947-8-79] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 11/26/2013] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Trichobezoars are an infrequent form of bezoar found in the stomach or intestine, created from ingested hair. This condition has been well described in the surgical literature, but less reported in psychiatry. CASE PRESENTATION We describe the case of an 18-year-old Middle Eastern Caucasian woman with trichotillomania who presented to our emergency department with a history of central abdominal pain associated with vomiting and constipation for five days. An examination showed a trichobezoar requiring emergent surgical intervention, and indicating the need for psychiatric treatment. The trichobezoar was treated successfully by laparotomy. CONCLUSION The medical and psychiatric sequelae of trichotillomania should not be underestimated, and early diagnosis and treatment is of utmost importance to save the patient's life and prevent recurrence. Although laparotomy is still considered an excellent option, pharmacotherapy and behavioral assessment play a useful role in patient management. Our case highlights the fundamental concept of a holistic approach rather than only treating the symptoms, by considering factors such as genetic influences to understand the disease.
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Affiliation(s)
| | | | | | | | - Allal Ouhtit
- Department of Genetics, College of Medicine, Sultan Qaboos University, Muscat, Oman
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47
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Javed A, Agarwal AK. A modified minimally invasive technique for the surgical management of large tricho bezoars. J Minim Access Surg 2013; 9:42-4. [PMID: 23626422 PMCID: PMC3630719 DOI: 10.4103/0972-9941.107142] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 04/05/2012] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND: Trichobezoar which were traditionally managed by open surgical retrieval are now often managed by minimally invasive surgical approach. Removal of a large trichobezoar by laparoscopy, however, needs an incision (usually 4-5 cm in size) for specimen removal and has the risk of intra-peritoneal spillage of hair and inspissated secretions. MATERIALS AND METHODS: The present paper describes a modified laparoscopy-assisted technique with temporary gastrocutaneopexy for the effective removal of a large trichobezoar using a camera port and a 4-5 cm incision (which is similar to that needed for specimen removal during laparoscopy). RESULTS: Three patients with large trichobezoar were managed with the described technique. The average duration of surgery was 45 (30-60) min and the intraoperative blood loss was minimal. There was no peritoneal spillage and the trichobezoar could be retrieved through a 4-5 cm incision in all patients. All had an uneventful recovery and at a median followup of 6 months had excellent cosmetic and functional results. CONCLUSION: The described technique is a minimally invasive alternative for trichobezoar removal. There is no risk of peritoneal contamination and the technical ease and short operative time in addition to an incision limited to size required for the specimen removal, makes it an attractive option.
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Affiliation(s)
- Amit Javed
- Department of GI Surgery, GB Pant Hospital & MAM College, New Delhi, India
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48
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Abstract
Rectal seed bezoars are an uncommon cause of fecal impaction, particularly in the United States. Although the literature has reported several cases of phytobezoars composed of various types of seeds, bezoars formed of pumpkin seeds have rarely been reported. We report a case of a man, aged 62 years, with a rectal bezoar composed of pumpkin seeds with complications necessitating extensive treatment, including manual disimpaction and colonoscopy.
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Affiliation(s)
- Janaki R Manne
- Department of Internal Medicine, Marshfield Clinic, 1000 North Oak Ave, Marshfield, WI 54449, USA.
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49
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Abstract
Diabetic gastroparesis (DGP), or slow emptying of the stomach, is a well-established complication of diabetes mellitus and is typically considered to occur in individuals with long-standing type 1 and type 2 diabetes mellitus. Clinical consequences of DGP include induction of gastrointestinal (GI) symptoms (early satiety, abdominal distension, reflux, stomach spasm, postprandial nausea, vomiting), alteration in drug absorption, and destabilization of glycemic control (due to mismatched postprandial glycemic and insulin peaks). Effective nutritional management not only helps in alleviating the symptoms, but also in facilitating better glycemic control. Although there have been no evidence-based guidelines pertaining to the nutrition care process of the DGP, the current dietary recommendations are based on expert opinions or observational studies. The dietary management of gastroparesis needs to be tailored according to the severity of malnutrition and kind of upper GI symptom by changing the volume, consistency, frequency, fiber, fat, and carbohydrates in the meal. Small frequent meals, using more liquid calories, reducing high fat or high fiber, consuming bezoar forming foods, and adjusting meal carbohydrates based on medications or insulin helps in improving the upper GI symptoms and glycemic control. Enteral nutrition can be an option for patients who fail to stabilize their weight loss, or for those who cannot gain weight with oral feedings, while total parenteral nutrition is rarely necessary for the patient with gastroparesis.
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Affiliation(s)
- Amena Sadiya
- Correspondence: Amena Sadiya, Rashid Centre for Diabetes and Research, Ministry of Health, Ajman, United Arab Emirates, Tel +97 167 147 345, Fax +97 167 434 547, Email
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50
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Abstract
Acute intestinal obstruction due to foreign bodies, or bezoar, is a rare occurrence in an adult with a normal intestinal tract. We report an unusual case of a 43-year-old black man with no previous abdominal surgery and no significant medical history who presented with an acute episode of small bowel obstruction due to an impacted undigested chicken bone.
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