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Liang Y, Huang L, Wang D, Liu T, Li X, Wang W, Shen Q, Han J, Li S, Wang L, Chen L. Rapunzel syndrome in children: a retrospective review of ten cases combined with literature review in a tertiary referral center. Pediatr Surg Int 2024; 40:121. [PMID: 38703237 DOI: 10.1007/s00383-024-05705-0] [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] [Accepted: 04/21/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE Rapunzel syndrome is an uncommon condition in children, and its clinical features remain unclear. This study presents the largest single-center series of pediatric cases to date, with the objective of documenting the clinical characteristics and treatment approaches for children with Rapunzel syndrome. METHODS A retrospective study was conducted in children with Rapunzel syndrome from 2019 to 2023. We recorded age, gender, symptoms, locations of bezoar, complications, and treatment options. RESULTS Ten patients with Rapunzel syndrome were included. The median age was 9.1 years, with all of whom were female. The most common clinical symptoms were upper abdominal mass (90%), abdominal pain (80%), and nausea and vomiting (50%). Complications occurred in six cases (60%), including small bowel obstruction (20%), severe gastric dilatation (10%), intestinal perforation (10%), choledochodilation (10%), acute pancreatitis with cholecystitis (10%). Preoperative ultrasonography suggested low-echoic foreign bodies continuing to the jejunum or ileocecal region in five cases (50%). Preoperative gastroscopy attempted in four cases (40%) to remove the foreign bodies, all of which failed. All patients underwent surgical treatment, with nine cases undergoing gastric incision foreign body removal, and one case undergoing gastric incision foreign body removal combined with intestinal perforation repair. All patients recovered well. No recurrence was observed during follow-up. CONCLUSION The accuracy of ultrasound diagnosis in identifying Rapunzel syndrome is high; however, it may lead to misdiagnosis if not complemented with the patient's medical history. Endoscopic presents a heightened treatment risk and a reduced success rate. The condition commonly presents with severe complications, thus making laparotomy a safe and effective option for intervention.
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Affiliation(s)
- Yiyuan Liang
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Liuming Huang
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China.
| | - Dayong Wang
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Tingting Liu
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xianling Li
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Qiulong Shen
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jinbao Han
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Shuanling Li
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Li Wang
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Long Chen
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
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2
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Di Girolamo N, Tollefson C. Computed tomographic diagnosis and clinical outcomes of small intestinal obstruction caused by trichobezoars in client-owned rabbits. Vet Radiol Ultrasound 2024; 65:264-274. [PMID: 38436052 DOI: 10.1111/vru.13349] [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] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/07/2023] [Accepted: 01/16/2024] [Indexed: 03/05/2024] Open
Abstract
Small intestinal obstruction in rabbits, although demonstrated to be common, is still poorly characterized. The objective of this study was to report features of small intestinal obstruction caused by trichobezoars in rabbits upon CT and their clinical outcomes. Rabbits with a diagnosis of intestinal obstruction that underwent CT scanning were included in this study. From each CT scan, obstruction location, appearance, Hounsfield units, size (mm), volume (mm3), distance from the stomach, and diameter of the small intestine proximal and distal to it, were extracted. Nine rabbits were included in the study. All rabbits presented for anorexia and had a distended or enlarged stomach (7) or abdomen (2). CT scan showed a non-contrast-enhancing, ovoid, smoothly marginated structure with a hyperattenuating rim, heterogeneous center, and variable amount of centrally located gas, in the duodenum (5), the jejunum (2), or the ileum (2). The density of the trichobezoars ranged from -156 to 58 HU (median, -44 HU) and volume ranged from 86.1 to 633.8 mm3 (median, 320.6 mm3). Three rabbits underwent medical management. Two of them survived, and one of them died. Six rabbits underwent surgery, of which three were successfully discharged from the hospital. CT proved to be a valuable imaging modality in rabbits with a suspected intestinal obstruction to provide the exact location of the obstruction and the characteristics of the obstructive material. The location and size of the trichobezoar may have relevant clinical implications.
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Affiliation(s)
- Nicola Di Girolamo
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Christopher Tollefson
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
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3
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Elghazeery MA, Hassan AM. Gastrointestinal Bezoars in Paediatrics: Case Series and Literature Review. Afr J Paediatr Surg 2024; 21:101-106. [PMID: 38546247 PMCID: PMC11003570 DOI: 10.4103/ajps.ajps_104_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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/30/2022] [Accepted: 12/08/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Bezoars are indigestible lumps which are usually found in stomach. Types of bezoar include phytobezoar, trichobezoar, lithobezoar, pharmacobezoar, plasticobezoar, lactobezoar and metal bezoar. Trichobezoars mostly affect females in 20s and 30s with a rarity in paediatrics. Unexplained complaints with a palpable mass are commonly found in these patients. Treatment involves retrieval of mass with searching for others. The purpose of this study was to present data and surgical management of cases with trichobezoars. MATERIALS AND METHODS We documented a retrospective review of trichobezoars done in our hospital between 2016 and 2022. All demographic data collected included gender and age of cases, composition and extent of bezoar, clinical presentation, imaging modalities, endoscopic trial, surgical approach and outcome. RESULTS Five cases of gastrointestinal tract (GIT) trichobezoars underwent surgery. All cases were females between (13 and 16 years). Trichobezoars were three gastric, one ileal and one of combined gastric and colonic. Complaints were abdominal pain, vomiting, weight loss and halitosis. Three cases had a palpable abdominal mass. Different radiological modalities were performed. Endoscopic retrieval was tried in one patient and the laparoscopic approach in another one, but the first route failed. Laparotomy followed by gastrotomy, enterotomy and colotomy was done without complications. CONCLUSIONS Trichobezoars should be suspected in any child with unexplained abdominal complaints or with a palpable abdominal mass, especially in girls. Imaging can be done in different modalities for diagnosis. Endoscopic retrieval could be tried; however, its failure is common, necessitating laparotomy, which has an excellent outcome.
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Affiliation(s)
- Mohamed Ahmed Elghazeery
- Department of General Surgery, Pediatric Surgery Unit, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Alhassan Mohamed Hassan
- Department of General Surgery, Gastrointestinal Surgery Unit, Faculty of Medicine, Tanta University, Tanta, Egypt
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4
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Castillo-Leon E, Smith AD, Garza JM, Gold B. Multiple trichobezoars masked by polyps. J Pediatr Gastroenterol Nutr 2024; 78:743-744. [PMID: 38299261 DOI: 10.1002/jpn3.12052] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/04/2023] [Accepted: 08/10/2023] [Indexed: 02/02/2024]
Affiliation(s)
| | - Alexis D Smith
- Department of Pediatric Surgery, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Jose M Garza
- GI Care for Kids, LLC; Children's Center for Digestive Healthcare, LLC, Atlanta, Georgia, USA
| | - Benjamin Gold
- Department of Pediatric Surgery, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- GI Care for Kids, LLC; Children's Center for Digestive Healthcare, LLC, Atlanta, Georgia, USA
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5
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Wang L, Chen Y, Chen S, Gao Z, Qian Y, Chen Q. Gastrointestinal trichobezoars in the pediatric population: a retrospective study. BMC Pediatr 2024; 24:124. [PMID: 38365624 PMCID: PMC10870568 DOI: 10.1186/s12887-023-04489-x] [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: 08/13/2023] [Accepted: 12/16/2023] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Trichobezoar is an extremely rare condition characterized by a foreign body in the gastrointestinal tract (GIT) among children. The foreign body may exist in the digestive tract for several years, and it becomes evident if complications develop. The current study aimed to present 21 cases of GIT trichobezoars. METHODS Retrospective analysis of children who were diagnosed with trichobezoars between August 2012 and December 2022. Patient demographics, clinical presentation, diagnosis, and therapy were collected and analyzed.Twenty-one patients had GIT trichobezoars. Data were collected and analyzed retrospectively. RESULTS Twenty-one patients were identified. All patients were female. Their mean age at admission was 8.9 ± 1.9 years. Furthermore, 19 (90.5%) patients presented with abdominal pain, 16 (76.2%) with vomiting, and 13 (61.9%) with a palpable mass. Sixteen patients underwent gastroduodenoscopy. Among them, 15 had gastric trichobezoars. Moreover, 12 patients underwent computed tomography scan. Eight patients presented with gastric and small intestinal BZs, one presented with increased small intestinal contents with dilation, and one presented with abundant gastric contents. Then, 20 patients underwent surgery. Among them, five underwent laparoscopic-assisted minilaparotomy (LAML), and the rest underwent laparotomy. The results showed that 10 (50%) patients had gastric trichobezoars; 7 (35%), Rapunzel syndrome; and 3 (15%), small bowel trichobezoars. Two patients developed superficial wound infection postoperatively. One patient had a recurrent gastric trichobezoar. CONCLUSION Trichobezoar should be considered in young girls with a history of hair eating or those with hair in the vomit or feces. Timely diagnosis and aggressive treatment are the keys to reducing complications and improving prognosis. Laparoscopic-assisted minilaparotomy is a safe, feasible, and effective surgical method for treating trichobezoars.
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Affiliation(s)
- Linyan Wang
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, 310052, China
| | - Yi Chen
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, 310052, China
| | - Sai Chen
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, 310052, China
| | - Zhigang Gao
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, 310052, China
| | - Yunzhong Qian
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, 310052, China
| | - Qingjiang Chen
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, 310052, China.
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Abstract
Rapunzel syndrome is a rare disorder characterized by a trichobezoar in the gastroduodenal tract caused by trichophagia. Diagnosis was confirmed by upper endoscopy and treatment was surgical.
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Affiliation(s)
- Antoine Poirier
- CHR Metz-Thionville, Hospital of Mercy, 1, allée du Château, 57245 Ars-Laquenexy, France.
| | - Amélie Delens
- CHR Metz-Thionville, Hospital of Mercy, 1, allée du Château, 57245 Ars-Laquenexy, France
| | - Thomas Serradori
- CHR Metz-Thionville, Hospital of Mercy, 1, allée du Château, 57245 Ars-Laquenexy, France
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7
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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 2024; 52:128-131. [PMID: 38518244 DOI: 10.36740/merkur202401119] [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] [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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8
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Hu X, Guo Q, Ma T, Liu WH. A novel bezoaratom angel fragmentation for therapy of a giant gastric bezoar (with video). Gastrointest Endosc 2023; 98:1026-1028. [PMID: 37390866 DOI: 10.1016/j.gie.2023.06.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/10/2023] [Accepted: 06/22/2023] [Indexed: 07/02/2023]
Affiliation(s)
- Xiao Hu
- Department of Gastroenterology and Hepatology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Qiang Guo
- Department of Gastroenterology and Hepatology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China; Department of Endocrinology, The People's Hospital of Jianyang City, Jianyang, Sichuan Province, China
| | - Tao Ma
- Department of Gastroenterology and Hepatology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Wei-Hui Liu
- Department of Gastroenterology and Hepatology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
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Chiang E, Balasubramanian S, Rabiner JE. Point-of-Care Ultrasound of a Pediatric Gastric Trichobezoar: A Case Report. Pediatr Emerg Care 2023; 39:892-894. [PMID: 37815310 DOI: 10.1097/pec.0000000000003062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
ABSTRACT This case report describes a previously healthy pediatric patient with acute onset of abdominal pain and distention who was found to have an epigastric mass on physical examination. Point-of-care ultrasound (POCUS) demonstrated a large gastric mass with ultrasonographic features consistent with a trichobezoar. After POCUS was performed, trichophagia was confirmed on history, and the patient went to the operating room for removal of a large trichobezoar. We conclude POCUS may be helpful for evaluation of epigastric masses and diagnosis of gastric trichobezoars. We review the ultrasound technique, sonographic findings, and literature regarding ultrasound diagnosis of trichobezoars.
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Affiliation(s)
- Elaine Chiang
- From the Division of Pediatric Emergency Medicine, Department of Emergency Medicine, New York-Presbyterian Morgan Stanley Children's Hospital/Columbia University Irving Medical Center, New York, NY
| | - Shriman Balasubramanian
- Department of Emergency Medicine, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Joni E Rabiner
- From the Division of Pediatric Emergency Medicine, Department of Emergency Medicine, New York-Presbyterian Morgan Stanley Children's Hospital/Columbia University Irving Medical Center, New York, NY
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10
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Yanari S, Sasaki S, Sato H, Ishida K, Kojika M, Inoue Y, Mase T, Sasaki A. Potentially Lethal Combination of Fruit and Gastric Acid: The Persimmon Bezoar Causing Esophageal Rupture. Am J Gastroenterol 2023; 118:1918. [PMID: 37307536 DOI: 10.14309/ajg.0000000000002356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/25/2023] [Indexed: 06/14/2023]
Affiliation(s)
- Shingo Yanari
- Department of Surgery, Iwate Medical University, School of Medicine, Iwate, Japan
| | - Shusaku Sasaki
- Department of Surgery, Iwate Medical University, School of Medicine, Iwate, Japan
| | - Hisaho Sato
- Department of Critical Care Medicine, Iwate Medical University, School of Medicine, Iwate, Japan
| | - Kaoru Ishida
- Department of Surgery, Iwate Medical University, School of Medicine, Iwate, Japan
| | - Masahiro Kojika
- Department of Surgery, Iwate Medical University, School of Medicine, Iwate, Japan
- Department of Critical Care Medicine, Iwate Medical University, School of Medicine, Iwate, Japan
| | - Yoshihiro Inoue
- Department of Critical Care Medicine, Iwate Medical University, School of Medicine, Iwate, Japan
| | - Tomohiko Mase
- Department of Critical Care Medicine, Iwate Medical University, School of Medicine, Iwate, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University, School of Medicine, Iwate, Japan
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11
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Kaba M, Karadağ ÇA, Sever N, Ser İ, Demir M, Yıldız A, Usta AM. A rare cause of intestinal obstruction in children trichobezoar: How to diagnose? ULUS TRAVMA ACIL CER 2023; 29:1288-1295. [PMID: 37889030 PMCID: PMC10771247 DOI: 10.14744/tjtes.2023.08434] [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] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 07/25/2023] [Accepted: 10/02/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Trichobezoar is a rare clinical condition in children, which is caused by the accumulation of swallowed hair mass in the digestive tract. This condition is most common in young women with psychiatric histories who suffer from trichotillomania (TTM), where they have an irresistible urge to pull out their hair. Diagnosis and treatment of this pathology, which is already extremely rare, and its variable clinical presentations are challenging. The aim of this study was to increase awareness of trichobezoar in the differential diagnosis of signs of intestinal obstruction in children and to evaluate the diagnosis and management of this rare pathology. METHODS The clinical data of six patients who were treated for trichobezoars in the pediatric surgery department of our hospital between 2009 and 2022 were retrospectively analyzed. RESULTS Six female patients were treated with the diagnosis of trichobezoar during this period. Patients were diagnosed with the help of anamnesis, physical examination, abdominal ultrasonography (USG), and finally, endoscopy. USG can predict the intestinal wall infiltration and the tail extended to the duodenum through pylorus in the series. All patients were evaluated with contrast-enhanced abdominal radiography. Five surgical interventions were performed in four of the cases. In a case who underwent surgery twice, the distal intestinal satellite bezoar was not noticed in the first operation. Two patients were diagnosed to have trichobezoar, but surgery was not required. These patients were younger and had early-onset TTM (before 10 years old). The patients were followed for an average of 10.8 years and no recurrence was detected. CONCLUSION Trichobezoar is a rare cause of intestinal obstruction in children with fatal complications when diagnosed late. Failure to follow an algorithm for the management of the disease causes difficulties in the diagnosis and treatment. Especially in pa-tients with a known psychiatric history, whole abdominal USG and laparoscopy performed with awareness can prevent unnecessary examinations.
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Affiliation(s)
- Meltem Kaba
- Department of Pediatric Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul-Türkiye
| | - Çetin Ali Karadağ
- Department of Pediatric Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul-Türkiye
| | - Nihat Sever
- Department of Pediatric Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul-Türkiye
| | - İlayda Ser
- Department of Pediatric Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul-Türkiye
| | - Mesut Demir
- Department of Pediatric Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul-Türkiye
| | - Abdullah Yıldız
- Department of Pediatric Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul-Türkiye
| | - Ayşe Merve Usta
- Department of Pediatric Gastroenterology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul-Türkiye
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12
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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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13
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Harrison NL, Santoro G, Ellerby N, Samad A. Small bowel obstruction secondary to phytobezoar in a patient with myotonic dystrophy. BMJ Case Rep 2023; 16:e255895. [PMID: 37798036 PMCID: PMC10565290 DOI: 10.1136/bcr-2023-255895] [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] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
A male patient in his 30s, with myotonic dystrophy (DM), presented to the emergency department with abdominal pain and vomiting. CT imaging revealed a soft tissue lesion in the terminal ileum causing small bowel obstruction (SBO). The patient underwent diagnostic laparoscopy which allowed identification and removal of the obstructing lesion. This was in the form of an intact, undigested potato, a phytobezoar. Bezoars are collections of undigested material found in the gastrointestinal (GI) tract, a phytobezoar is composed of plant material and is the most common form of bezoar. DM is a multisystem disorder characterised by skeletal muscle weakness, however it often presents with GI symptoms and the muscles of mastication are often affected. DM is a known risk factor for bezoar formation and should be considered as an important differential in DM patients presenting with SBO.
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Affiliation(s)
- Nicholas L Harrison
- St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, Merseyside, UK
| | - Giovanni Santoro
- St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, Merseyside, UK
| | - Nicolas Ellerby
- St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, Merseyside, UK
| | - Ajai Samad
- St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, Merseyside, UK
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14
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Chuah YY, Lee YY, Hsu PI. Ulceration caused by a persimmon bezoar. Br J Hosp Med (Lond) 2023; 84:1. [PMID: 37769261 DOI: 10.12968/hmed.2023.0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Affiliation(s)
- Yoen Young Chuah
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ping Tung Christian Hospital, Taiwan
- Department of Nursing, Meiho University, Pingtung, Taiwan
| | - Yeong Yeh Lee
- Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bahru, Malaysia
| | - Ping-I Hsu
- Division of Gastroenterology, Department of Medicine, An Nan Hospital, China Medical University, Tainan, Taiwan
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15
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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16
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Lara-Zavala YY, Álvarez-Ciaca I, Montiel-Jarquin ÁJ, Bertado-Ramírez NR, García-Galicia A, Alonso-Torres G. [Rapunzel syndrome: Radiological diagnosis]. Rev Med Inst Mex Seguro Soc 2023; 61:539-542. [PMID: 37540757 PMCID: PMC10484550 DOI: 10.5281/zenodo.8200619] [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] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/08/2023] [Indexed: 08/06/2023]
Abstract
Background Rapunzel syndrome is a rare presentation of trichobezoar, secondary to the ingestion of hair known as trichophagia. This bezoar has been found mainly in women, it invades the stomach and extends to the small intestine. Clinically, patients present weight loss and chronic obstructive symptoms at the intestinal level. A case of Rapunzel syndrome is presented. Clinical case A 13-year-old female presented with a weight loss of 10kg in two months, chronic constipation, predominantly nocturnal vomiting, and abdominal pain of seven days' duration. Physical examination revealed decreased peristalsis and a palpable mass in the epigastrium. Laboratories taken on admission: normal blood count, kidney function tests, and liver function tests. The abdominal X-ray showed opacity in the fundus, body and gastric antrum, the abdominal ultrasound showed non-specific findings in the epigastrium, later an abdominal tomography was performed with a swallow of water-soluble contrast medium and showed occupation in the gastric lumen. She underwent exploratory laparotomy and the finding was a trichobezoar in the stomach with extension to the duodenum and part of the jejunum, which was removed without complications. The evolution of the patient was favorable. Conclusions For the diagnosis of Rapunzel Syndrome, the use of contrast imaging studies is necessary, and the treatment of choice is surgical.
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Affiliation(s)
- Yhessica Yhazmin Lara-Zavala
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “General de División Manuel Ávila Camacho”, Hospital de Especialidades de Puebla, Servicio de Radiología. Puebla, Puebla, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Inés Álvarez-Ciaca
- Instituto Mexicano del Seguro Social, Hospital General de Zona No. 20, Servicio de Radiología. Puebla, Puebla, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Álvaro José Montiel-Jarquin
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “General de División Manuel Ávila Camacho”, Hospital de Especialidades de Puebla, Dirección de Educación e Investigación en Salud. Puebla, Puebla, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Nancy Rosalía Bertado-Ramírez
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “General de División Manuel Ávila Camacho”, Hospital de Especialidades de Puebla, Dirección de Educación e Investigación en Salud. Puebla, Puebla, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Arturo García-Galicia
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “General de División Manuel Ávila Camacho”, Hospital de Especialidades de Puebla, Dirección de Educación e Investigación en Salud. Puebla, Puebla, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Gisela Alonso-Torres
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “General de División Manuel Ávila Camacho”, Hospital de Especialidades de Puebla, Dirección de Educación e Investigación en Salud. Puebla, Puebla, MéxicoInstituto Mexicano del Seguro SocialMéxico
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17
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Ng DYL, Wilkie B, Chubb DP. Small bowel obstruction secondary to Meckel's diverticulum impacted with phytobezoar. ANZ J Surg 2023; 93:2036-2037. [PMID: 37272241 DOI: 10.1111/ans.18548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/21/2023] [Indexed: 06/06/2023]
Affiliation(s)
- Daniel Yee Lee Ng
- Department of General Surgery, Albury Wodonga Health, Albury, New South Wales, Australia
| | - Bruce Wilkie
- Department of General Surgery, Albury Wodonga Health, Albury, New South Wales, Australia
| | - Daniel Peter Chubb
- Department of General Surgery, Albury Wodonga Health, Albury, New South Wales, Australia
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18
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Pan X, Lu M, Guo L, Niu X, Li F. A novel method of lithotripsy of a large luminal bezoar stone by use of an ERCP guidewire. Gastrointest Endosc 2023; 98:135-136. [PMID: 36693502 DOI: 10.1016/j.gie.2023.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/18/2023] [Indexed: 01/26/2023]
Affiliation(s)
- Xinzhi Pan
- Department of Gastroenterology, Lianzhou People's Hospital, Guangdong Province, China
| | - Meiguang Lu
- Department of Gastroenterology, Lianzhou People's Hospital, Guangdong Province, China
| | - Limei Guo
- Department of Gastroenterology, Lianzhou People's Hospital, Guangdong Province, China
| | - Xianghong Niu
- Department of Gastroenterology, Lianzhou People's Hospital, Guangdong Province, China
| | - Feng Li
- Department of Gastroenterology and Hepatology, Christus Mother Frances Hospital and Clinic Tyler, Texas, USA
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19
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Adotti V, Rosi M, Prosperi P, Vizzutti F. Trichobezoar causing gastric outlet obstruction in a patient with trichotillomania. United European Gastroenterol J 2023; 11:482-483. [PMID: 37186210 PMCID: PMC10256992 DOI: 10.1002/ueg2.12395] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023] Open
Affiliation(s)
- Valentina Adotti
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
| | - Martina Rosi
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
| | - Paolo Prosperi
- Emergency Surgery UnitDEA DepartmentCareggi University HospitalFlorenceItaly
| | - Francesco Vizzutti
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
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20
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Kwon HJ, Park J. Treatment of large gastric trichobezoar in children: Two case reports and literature review. Medicine (Baltimore) 2023; 102:e33589. [PMID: 37083802 PMCID: PMC10118359 DOI: 10.1097/md.0000000000033589] [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: 03/09/2023] [Accepted: 03/31/2023] [Indexed: 04/22/2023] Open
Abstract
RATIONALE Gastric trichobezoars are a rare form of bezoar formed from swallowed human hair as well as hair from dolls or animals, blankets, and carpets. They usually develop in young women who are emotionally disturbed, depressed, or mentally retarded, with trichotillomania and trichophagia. They can lead to abdominal pain, gastric ulceration, bleeding, obstruction, and perforation. PATIENT CONCERNS A 13-year-old girl was admitted to our institution with complaints of nausea, vomiting, and epigastric pain for 2 days. She underwent laparoscopic removal of a large gastric trichobezoar at our institution 5 years ago. A 12-year-old girl presented at our institution due to epigastric pain, dizziness, and melena for 2 days. DIAGNOSIS They were diagnosed with gastric trichobezoar by abdominal computed tomography scan and upper gastrointestinal endoscopy. INTERVENTIONS Large gastric trichobezoars were removed via a mini-laparotomy. OUTCOMES They recovered well postoperatively without complication. LESSONS Although the recurrence of gastric trichobezoar after surgery is rare, few recurrent cases were reported in the literature. Therefore, psychiatric consultation and regular follow-up after treatment should be considered in the children and their parents to prevent the recurrence of gastric trichobezoar.
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Affiliation(s)
- Hyung Jun Kwon
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Jinyoung Park
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
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21
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Ramaiah S, Bekas S, Annaiah TK. Trichobezoar-A rare cause of hyperemesis in a pregnant woman. Eur J Obstet Gynecol Reprod Biol 2023; 283:164-166. [PMID: 36842899 DOI: 10.1016/j.ejogrb.2023.02.007] [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] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Abstract
Bezoars consist of ingested foreign material or organic matter which forms a mass in the gastrointestinal tract, usually in the stomach. Trichobezoars formed by swallowed hair may present with vomiting, malnutrition, weight loss or abdominal pain with signs of gastrointestinal obstruction. There are limited case reports of Trichobezoar during pregnancy. We present a case of young pregnant women who was admitted on few occasions with vomiting in early pregnancy and was treated as hyperemesis gravidarum. Failure of response to conventional management prompted further investigation, revealing trichobezoar. Our case highlights the diagnostic challenge posed by trichobezoars in young pregnant women.
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Affiliation(s)
- Sunitha Ramaiah
- Department of Obstetrics and Gynaecology, NorthWestAnglia NHS Trust, United Kingdom.
| | - Spyridon Bekas
- Department of Obstetrics and Gynaecology, NorthWestAnglia NHS Trust, United Kingdom
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22
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Mizumoto N, Sasaki Y, Abe Y, Yagi M, Onozato Y, Umehara M, Nakamura S, Tsuchida H, Ito M, Goto H, Ueno Y. An Unusual Small Bowel Phytobezoar Successfully Resolved by Double-balloon Enteroscopy. Intern Med 2023; 62:221-226. [PMID: 35676042 PMCID: PMC9908379 DOI: 10.2169/internalmedicine.9640-22] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
We herein report a very unusual case of small bowel obstruction caused by phytobezoar in a 69-year-old woman who consumed a large amount of bracken. The patient presented with nausea and vomiting. Computed tomography revealed an air-filled foreign body in the jejunum that had likely caused the small bowel obstruction. A fibrous foreign body diagnosed as a phytobezoar was detected using double-balloon enteroscopy. The obstruction was successfully resolved by crushing the phytobezoar repeatedly using a snare. Small bowel obstructions caused by phytobezoars are often treated with surgical interventions. However, endoscopic fragmentation using a snare is a minimally invasive treatment alternative.
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Affiliation(s)
- Naoko Mizumoto
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, Japan
| | - Yu Sasaki
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, Japan
| | - Yasuhiko Abe
- Division of Endoscopy, Yamagata University Hospital, Japan
| | - Makoto Yagi
- Division of Endoscopy, Yamagata University Hospital, Japan
| | - Yusuke Onozato
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, Japan
| | - Matsuki Umehara
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, Japan
| | - Shuhei Nakamura
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, Japan
| | - Hidemoto Tsuchida
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, Japan
| | - Minami Ito
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, Japan
| | - Hiroki Goto
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, Japan
| | - Yoshiyuki Ueno
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, Japan
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23
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Goh SLL, Steen C, Wong E, Scott M. Small bowel obstruction secondary to a plastic bezoar. BMJ Case Rep 2022; 15:e251438. [PMID: 36446472 PMCID: PMC9710328 DOI: 10.1136/bcr-2022-251438] [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] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
We present a case of a small bowel obstruction secondary to a rare plastic bezoar. A man in their early 20s with autism and an intellectual disability presented with symptoms of small bowel obstruction. CT revealed very subtle signs and, despite passage of gastrografin, ongoing clinical suspicion led to operative management which confirmed the diagnoses of plastic bezoar.
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Affiliation(s)
| | | | - Enoch Wong
- General Surgery, Eastern Health, Box Hill, Victoria, Australia
| | - Monique Scott
- Department of Pscyhology, Swinburne University of Technology, Hawthorn, Victoria, Australia
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24
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Muñiz-Muñoz M, Segovia-Alonso P, Delgado-Álvarez MP, Villanueva-Hernández R. Esophageal bezoar: A multidisciplinary approach. Rev Gastroenterol Mex (Engl Ed) 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] [What about the content of this article? (0)] [Affiliation(s)] [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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25
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Nissen M, Tröbs RB. Epigastric Mass-a 4-Year-Old With Trichobezoar and Anemia. Dtsch Arztebl Int 2022; 119:252. [PMID: 35794802 PMCID: PMC9358350 DOI: 10.3238/arztebl.m2022.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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26
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Affiliation(s)
- Mitchell Edwards
- Veterans Affairs Puget Sound Health Care System, Hospital and Specialty Medicine, Seattle, WA, USA.
- Department of Medicine, University of Washington, Seattle, WA, USA.
| | - Andrew Kaz
- Veterans Affairs Puget Sound Health Care System, Hospital and Specialty Medicine, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Pandora L Wander
- Veterans Affairs Puget Sound Health Care System, Hospital and Specialty Medicine, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
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27
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Lai WC, Tay SP. Small bowel obstruction secondary to crab shell bezoar: A case report. Med J Malaysia 2022; 77:252-254. [PMID: 35338638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Small bowel obstruction is a common surgical condition that needs surgical intervention if conservative measures fail. Bezoar is a rare aetiology of small bowel obstruction with incidence of 4.5%. The bezoars can be grouped, according to the content, into four common types: phytobezoars, trichobezoars, pharmacobezoars, and lactobezoars. However, unusual bezoars like plastic bezoars and metal bezoars have been reported too. Herein, we report a case of an elderly lady who was treated for small bowel obstruction due to crab shell bezoar. This is the first case reported in literature. Ingestion of large intact pieces of crab shell should be avoided due to the potential of causing small bowel obstruction.
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Affiliation(s)
- W C Lai
- University of Malaya Medical Centre, Department of Surgery, Kuala Lumpur, Malaysia.
| | - S P Tay
- Hospital Sultan Ismail, Department of General Surgery, Johor Bahru, Malaysia
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28
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Ota K, Kawaguchi S, Iwatsubo T, Nishida S, Tanaka H, Mori Y, Nakajima N, Hakoda A, Sugawara N, Kojima Y, Takeuchi T, Sakaguchi M, Higuchi K. Tannin-phytobezoars with Gastric Outlet Obstruction Treated by Dissolution with Administration and Endoscopic Injection of Coca-Cola ®, Endoscopic Crushing, and Removal (with Video). Intern Med 2022; 61:335-338. [PMID: 34334573 PMCID: PMC8866791 DOI: 10.2169/internalmedicine.8090-21] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A 77-year-old man complained of postmeal vomiting and sustained general fatigue. An abdominal computed tomography scan showed massive gastric expansion and fluid storage. Gastroscopy revealed four gastric bezoars that were considered to have caused pyloric ring obstruction. The patient was asked to drink 500 mL per day of Coca-Cola® for 4 days. On the fourth day, we performed endoscopic crushing and removal by injecting Coca-Cola®, cutting the softened bezoar with endoscopic snares, and collecting the pieces with endoscopic nets. We herein report (with a video presentation) a rare case of tannin-phytobezoars endoscopically removed with the administration and injection of Coca-Cola®.
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Affiliation(s)
- Kazuhiro Ota
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Shimpei Kawaguchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Taro Iwatsubo
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Shinya Nishida
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Hironori Tanaka
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Yosuke Mori
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Noriyuki Nakajima
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Akitoshi Hakoda
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Noriaki Sugawara
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Yuichi Kojima
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Toshihisa Takeuchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
| | | | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Japan
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29
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Folmann K, Malmstrøm ML. [Atypisk ileus forørsaget af bezoar af handsker]. Ugeskr Laeger 2022; 184:V71079. [PMID: 35060478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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30
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Abstract
Rapunzel syndrome is rare and describes a trichobezoar that extends through the pylorus into the jejunum, ileum or even the colon. Due to the large intraluminal size and weight they can attain, acute presentations of obstruction or perforation may occur. We report a case of a 17-year-old girl who presented to the emergency department following a syncopal episode. On examination, a left upper quadrant mass was appreciated with no signs of peritonism. Contrast-enhanced CT demonstrated a giant trichobezoar with resulting gastric perforation and intra-abdominal free fluid. Laparotomy and gastrotomy were performed and the patient had an uneventful recovery with psychiatric review prior to discharge. Though uncommon, bezoars should be included in our differential diagnosis as they can present in various ways owing to their size and weight. This case illustrates the risk of gastric perforation with large gastric bezoars.
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Affiliation(s)
- Jamaall Jackman
- General Surgery, Queen's Medical Centre Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Gael R Nana
- General Surgery, Queen's Medical Centre Nottingham University Hospital NHS Trust, Nottingham, UK
| | - James Catton
- General Surgery, Queen's Medical Centre Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Ioannis Christakis
- General Surgery, Queen's Medical Centre Nottingham University Hospital NHS Trust, Nottingham, UK
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Abstract
A 34-year-old woman presented with abdominal pain for 2 months. Abdominal CT revealed a large bezoar in the distal ileum with surrounding thickened ileal wall and enlarged mesentery lymph nodes. On FDG PET/CT, the thickened ileal wall and enlarged mesentery lymph nodes showed increased FDG uptake. Ileal malignancy with mesentery lymph node metastasis was suspected. The distal ileum and enlarged mesentery lymph nodes were removed. Benign ileal ulcer and mesentery reactive lymphoid hyperplasia were confirmed by histopathology.
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Affiliation(s)
- Xia Ji
- From the Department of Gastroenterology, The Second Affiliated Hospital, Jiaxing University, Jiaxing
| | - Hui Dong
- Department of Pathology, Eastern Hepatobiliary Surgery Hospital
| | - Aisheng Dong
- Department of Nuclear Medicine, Changhai Hospital, Navy Military Medical University, Shanghai, China
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32
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Ohnesorge S, Skari H, Zochowski K, Pekrun EM, Schistad O, Næss PA. Trichobezoar. Tidsskr Nor Laegeforen 2020; 140:20-0472. [PMID: 33231405 DOI: 10.4045/tidsskr.20.0472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Rapunzel syndrome refers to a gastric bezoar with post-pyloric extension. CASE PRESENTATION A child of primary school age presented with four days of abdominal pain, nausea, vomiting and a non-tender palpable mass in the upper part of the abdomen. The child had a history of trichotillomania and trichotillophagia. Preoperative imaging including abdominal ultrasound and upper gastrointestinal series was suggestive of gastric bezoar extending into the duodenum. At laparotomy and gastrotomy a large trichobezoar which had taken the shape of the stomach with a 60 cm long tail extending into the jejunum was removed. The child had an uneventful recovery and was discharged home on the fifth postoperative day. INTERPRETATION Although rare, trichobezoar should be considered as a differential diagnosis for abdominal pain in young patients with a known history of trichotillomania and trichotillophagia.
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33
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Sert OZ. Multiple small bowel perforation in a young adult female due to Rapunzel Syndrome. Ann Ital Chir 2020; 9:S2239253X20034258. [PMID: 33170155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Rapunzel's syndrome is the state of the gastric trichobezoar (hair ball) extending to the small intestine. Although it is seen very rarely, it is a psychiatric and mental illness especially in young women. We present here, a young female with recurrent trichotillomania. CASE PRESENTATION In a 24-year-old patient who underwent laparotomy due to recurrent trichobezoar, which completely filled the stomach and extended to the small intestine, caused perforation in two places in the small intestine, was removed by gastrotomy and enterotomy. One of the perforated areas was very close to ligament of Treitz, and perforation occurred due to the ulcer caused by trichobezoar. Post-operative central total parenteral nutrition was given and oral intake was started at the end of the first week. The patient was referred to psychiatry and antipsychotic medication was started. She was discharged on the 9th postoperative day without any problem. CONCLUSION Although there are no signs of peritonitis in such Rapunzel syndrome cases, a detailed exploration should be made by keeping in mind that trichobezoar will cause ulceration and perforation. In addition, as the primary cause is the underlying psychiatric disorder, patients should be referred to the psychiatry clinic to prevent recurrence. KEY WORDS Adult, Rapunzel syndrome, Surgery, Trichobezoar, Trichotillomania.
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Tien L, Drevets PD, Chung JM, Sheff S. Esophageal Obstruction due to Common Seedless Banana Phytobezoar. Am Surg 2020; 88:2402-2403. [PMID: 32967436 DOI: 10.1177/0003134820951448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Lillie Tien
- 1421 Department of Surgery, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Peter D Drevets
- 1421 Department of Surgery, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Jane M Chung
- 1421 Department of Surgery, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Sean Sheff
- Department of Surgery, Phoebe Sumter Medical Center, Americus, GA, USA
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Manchanda V, Biswas S, Ghai A, Goyal S. Duodenal Web with Trichobezoar: An Unusual Presentation. Indian Pediatr 2020; 57:757. [PMID: 32844767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Vivek Manchanda
- Department of Paediatric Surgery, Jaipur Golden Hospital, New Delhi, India.
| | - Shekhar Biswas
- Department of Paediatrics, Jaipur Golden Hospital, New Delhi, India
| | - Anirudh Ghai
- Department of Paediatrics, Jaipur Golden Hospital, New Delhi, India
| | - Sanjay Goyal
- Department of Radiodiagnosis, Jaipur Golden Hospital, New Delhi, India
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Appak YÇ, Ertan D, Karakoyun M, Özyurt G, Özdemir T, Baran M. The cause of abdominal mass in a child with celiac disease: Rapunzel syndrome. A case report. SAO PAULO MED J 2019; 137:292-294. [PMID: 29590232 PMCID: PMC9743995 DOI: 10.1590/1516-3180.2017.0281141017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/14/2017] [Indexed: 12/15/2022] Open
Abstract
CONTEXT Rapunzel syndrome is a rare form of gastric trichobezoar that develops through outstretching of the bezoar from the stomach to the intestine. CASE REPORT A 12-year-old girl who had been diagnosed with celiac disease six years earlier was brought to the department of pediatric gastroenterology because of abdominal distension. A palpable mass was detected. A trichobezoar that stretched to the small intestine was removed surgically. The patient was diagnosed as having anxiety and depressive disorder, and treatment started. Following the treatment, her previous trichophagia completely disappeared. CONCLUSION Presence of trichobezoar should be kept in mind, especially when young girls who have psychiatric problems suffer from gastrointestinal symptoms.
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Affiliation(s)
- Yeliz Çağan Appak
- MD. Attending Physician, Department of Pediatric Gastroenterology, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - Duygu Ertan
- MD. Pediatric Assistant, Department of Pediatrics, Tepecik Training and Research Hospital, İzmir, Turkey.
| | - Miray Karakoyun
- MD. Attending Physician, Department of Pediatric Gastroenterology, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - Gonca Özyurt
- MD. Assistant Professor, Department of Child and Adolescent Psychiatry, Tepecik Training and Research Hospital, Izmir Katip Celebi University School of Medicine, İzmir, Turkey.
| | - Tunç Özdemir
- MD. Associate Professor, Department of Pediatric Surgery, Tepecik Training and Research Hospital, İzmir, Turkey.
| | - Maşallah Baran
- MD. Associate Professor, Department of Pediatric Gastroenterology, Tepecik Training and Research Hospital, Izmir Katip Celebi University School of Medicine, İzmir, Turkey.
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Soria Alcívar M, Betancourt Ruiz M, Moyon Gusñay M, Chavez Almeida J, Abarca Rendón F, Robles-Medranda C. [Giant Rapunzel syndrome with atypical complication. Report of a case]. Rev Gastroenterol Peru 2019; 39:74-77. [PMID: 31042240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Rapunzel syndrome is an unusual and rare form of gastric trichobezoar that extends into the small intestine. The formation is due to the continuous ingestion of hair which leads to the impaction of the hair along with mucus and food, but it is rare that gastric perforation occurs. We report the case of a female patient of 16 years of age admitted to our institution with a history of depression and clinical symptoms characterized by nausea, severe epigastralgia and pathological loss of weight. The physical examination showed a tense abdomen with a peritoneal reaction. Contrast-enhanced tomography showed a distended stomach with a heterogeneous content that extended to the duodenum, hydro pneumoperitoneum, Douglas sack bottom liquid, and it was decided to perform an exploratory laparotomy. Showed perforation in the anterior face of the stomach which is infrequent, so we proceeded to the extraction of giant trichobezoar with duodenal extension; Evolving favorably, the patient being referred to outpatient controls with psychiatry; Finally, a high endoscopy was performed at 6 months, which evidenced the scar of the surgical procedure.
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Affiliation(s)
- Miguel Soria Alcívar
- Instituto Ecuatoriano de Enfermedades Digestivas. Guayaquil, Ecuador; Universidad de Guayaquil. Guayaquil, Ecuador
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Stein J, Latz S, Ellinger J, Fechner G, Safi M, Krausewitz P, Müller S, Weyer K, Müller SC. Fungaemia caused by obstructive renal candida bezoars leads to bilateral chorioretinitis: a case report. BMC Urol 2018; 18:21. [PMID: 29548319 PMCID: PMC5857136 DOI: 10.1186/s12894-018-0335-6] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/12/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Renal fungal bezoars are remarkably rare and mostly occur in immunodeficient patients. Only a small number of cases with immunocompetent patients have been published so far. The published treatment approaches comprised systemic antimycotic therapy and surgical or minimal invasive removal of the fungal balls. In some cases irrigation of the renal duct system with amphotericin B was performed. By obstruction of the urinary tract bezoars can lead to infected hydronephrosis and severe urosepsis with high lethality. Fungaemia can cause fungal colonization in different distant organs. Fulminant chorioretinitis and irreversible visual impairment can be the consequence of ocular fundus colonization. The following report highlights that a co-operation between urologists and ophthalmologists is absolutely indispensible in case of fungaemia. CASE PRESENTATION Hereinafter we describe a case of an immunocompetent 56 years old woman, presenting with flank pain and shivering. The diagnosis turned out to be difficult due to initially negative urine culture. The fungaemia caused by obstructive nephropathy led to bilateral candida chorioretinitis. The patient was treated with intravenous amphotericin b and the bezoar was removed by percutaneous "nephrolitholapaxy". After two months, a follow up revealed the patient felt well, chorioretinal lesions regressed and urine culture did not show any fungal growth. CONCLUSION To the best of our knowledge, this is the first case reporting on obstructive renal bezoars, which lead to haematogenous fungus spread and bilateral chorioretinitis. It points out that extensive ophthalmologic examination should be performed in case of fungaemia even if the patient is not suffering from any visual impairment.
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Affiliation(s)
- Johannes Stein
- Department of Urology, University of Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
| | - Stefan Latz
- Department of Urology, University of Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
| | - Jörg Ellinger
- Department of Urology, University of Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
| | - Guido Fechner
- Department of Urology, University of Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
| | - Maher Safi
- Department of Urology, University of Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
| | - Philipp Krausewitz
- Department of Urology, University of Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
| | - Simone Müller
- Department of Ophthalmology, University of Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
| | - Karin Weyer
- Department of Urology, University of Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
| | - Stefan C. Müller
- Department of Urology, University of Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
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Sy S, Siddiki H, Horsley-Silva J, Byrne T, Lam-Himlin D. Sevelamer resin bezoar presenting as a cecal mass. Gastrointest Endosc 2017; 86:1186-1187. [PMID: 28673643 DOI: 10.1016/j.gie.2017.06.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 06/26/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Sabrina Sy
- Department of Laboratory Medicine and Pathology, Mayo Clinic in Arizona, Scottsdale, Arizona, USA
| | - Hassan Siddiki
- Division of Gastroenterology and Hepatology, Mayo Clinic in Arizona, Scottsdale, Arizona, USA
| | - Jennifer Horsley-Silva
- Division of Gastroenterology and Hepatology, Mayo Clinic in Arizona, Scottsdale, Arizona, USA
| | - Thomas Byrne
- Division of Gastroenterology and Hepatology, Mayo Clinic in Arizona, Scottsdale, Arizona, USA
| | - Dora Lam-Himlin
- Department of Laboratory Medicine and Pathology, Mayo Clinic in Arizona, Scottsdale, Arizona, USA
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Mora-Guzmán I, Muñoz de Nova JL, Rodríguez Sánchez A. An unusual enterolith ileus. Rev Esp Enferm Dig 2017; 109:292. [PMID: 28372454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The duodenum is an uncommon location of diverticula in the digestive tract, and they are often asymptomatic. Formation of an enterolith inside diverticula has been previously described, although it is a rare condition. In this context, intestinal obstruction due to distal migration of foreign bodies is extremely rare. We report a case of an 86-year-old woman with obstructive symptoms due to a jejunal foreign body that had migrated from a duodenal diverticulum. An emergency laparotomy was performed to extract a phytobezoar. Enterolith ileus secondary to duodenal diverticula is an exceptional entity. Diagnosis and management are usually delayed because of a non-specific presentation, and early surgical exploration is required for bowel disimpaction. This condition should be considered in elderly patients with prolonged immobilization or neurodegenerative diseases.
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Affiliation(s)
- Ismael Mora-Guzmán
- Cirugía General y del Aparato Digestivo, Hospital Universitario de La Princesa, España
| | | | - Ana Rodríguez Sánchez
- Cirugía General y del Aparato Digestivo, Hospital Universitario de La Princesa, España
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O'Flynn L, Disney BR, Menon V, Mannath J. Trichobezoar and Rapunzel syndrome : an unusual cause of abdominal mass. Acta Gastroenterol Belg 2017; 80:81-82. [PMID: 29364106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Rovsing CM. Trichobezoars in the Stomach and Their Demonstration by Roentgen Examination. Acta Radiol 2016; 57:e232-e237. [PMID: 28196331 DOI: 10.1177/0284185116679594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Saldanha NE, Meisel JA, Prince JM, Feinstein R, Fisher M. Delayed diagnosis of trichobezoar in a patient with presumed anorexia nervosa. Int J Adolesc Med Health 2016; 27:349-52. [PMID: 25153372 DOI: 10.1515/ijamh-2014-0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 05/13/2014] [Indexed: 11/15/2022]
Abstract
Anorexia nervosa is a medical and psychological disorder classically seen in young women who present with significant weight loss, a distorted body image, and an intense fear of gaining weight despite being underweight. A rare diagnosis that is also associated with weight loss is a trichobezoar, a collection of hair or hair-like fibers in the gastrointestinal tract, primarily in the stomach. In this report, we present the case of a 14.5-year-old girl with weight loss caused by a trichobezoar, initially thought to be due to anorexia nervosa, and we review the details of both disorders.
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Affiliation(s)
- Vishal Sharma
- Department of Gastroenterology, PGIMER and Dr RML Hospital, Delhi, 110001, India.
| | - Hema Gupta
- Department of Paediatrics, PGIMER and Dr RML Hospital, Delhi, India
| | - Sandeep Lamoria
- Department of Gastroenterology, PGIMER and Dr RML Hospital, Delhi, 110001, India
| | - Arka De
- Department of Gastroenterology, PGIMER and Dr RML Hospital, Delhi, 110001, India
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Tamini N, Pinotti E, Uggeri F, Gianotti L. Chronic gastric obstruction due to giant trichobezoar in an adult with Rapunzel syndrome. Dig Liver Dis 2016; 48:452. [PMID: 26775094 DOI: 10.1016/j.dld.2015.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 12/18/2015] [Indexed: 12/11/2022]
Affiliation(s)
- N Tamini
- Department of Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, MI, Italy.
| | - E Pinotti
- Department of Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, MI, Italy
| | - F Uggeri
- Department of Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, MI, Italy
| | - L Gianotti
- Department of Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, MI, Italy
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Abstract
Gastric bezoars are concretions of undigested material, and Coca-Cola therapy is an easy, efficacious and safe approach for bezoar treatment. Gastric outlet obstruction due to a migratory gastric bezoar during Coca-Cola therapy is an uncommon presentation and, to the best of our knowledge, no cases have been previously reported. We herein describe one such case with no known predisposing factors that recovered via the endoscopic technique. A thorough literature search was performed, which yielded eight relevant patients from seven publications, all of who developed gastrointestinal obstruction during dissolution treatment and recovered uneventfully after surgical intervention. In conclusion, this potential complication should be kept in mind in the event that alternative treatment is necessary.
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Affiliation(s)
- Lei Lu
- Hangzhou First People's Hospital, Nanjing Medical University, China
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Affiliation(s)
- Hossein Hassanian-Moghaddam
- Toxicological Research Center, Department of Clinical Toxicology, Loghman-Hakim Hospital Poison Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Kamali Ave, South Karegar Street, Tehran, 13336, Iran.
- Excellence Center of Clinical Toxicology, Iranian Ministry of Health, Tehran, Iran.
| | - Nasim Zamani
- Toxicological Research Center, Department of Clinical Toxicology, Loghman-Hakim Hospital Poison Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Kamali Ave, South Karegar Street, Tehran, 13336, Iran
- Excellence Center of Clinical Toxicology, Iranian Ministry of Health, Tehran, Iran
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Wang PY, Wang X, Zhang L, Li HF, Chen L, Wang X, Wang B. Bezoar-induced small bowel obstruction: Clinical characteristics and diagnostic value of multi-slice spiral computed tomography. World J Gastroenterol 2015; 21:9774-9784. [PMID: 26361425 PMCID: PMC4562962 DOI: 10.3748/wjg.v21.i33.9774] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 04/25/2015] [Accepted: 06/16/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the possible predisposing factors of bezoar-induced small bowel obstruction (BI-SBO) and to discuss the diagnostic value of multi-slice spiral computed tomography, particularly contrast-enhanced scanning, in this condition.
METHODS: A total of 35 BI-SBO cases treated at our hospital from January 2007 to December 2013 were retrospectively analysed. Complete clinical and computed tomography (CT) data of the patients were available and confirmed by surgery. SBO was clinically diagnosed on the basis of clinical manifestations. Of the 35 patients, 18 underwent abdominal and pelvic CT planar scanning with GE 64-slice spiral CT and 17 underwent abdominal and pelvic CT planar scanning with GE 64-slice spiral CT combined with contrast-enhanced examination. Original images were processed using a GE ADW4.3 workstation to obtain MPR, CPR, MIP and CTA images. The images of all patients were evaluated by two abdominal imaging experts. The main analytical contents of planar scanning included intestinal bezoar conditions, changes in the intestinal wall and changes in peri-intestinal conditions. Vascular hyperaemia and arterial blood supply conditions at a specific obstruction site and the distal end of the obstruction site were evaluated through contrast-enhanced examination.
RESULTS: The proportion of males to females among the 35 cases was 1:1.69 (13:22); median age was 63.3 years. The following cases were observed: 29 (82.8%) cases occurred in autumn and winter and showed a history of consuming high amounts of persimmon and hawthorn; 19 (54.3%) cases revealed a history of gastrointestinal surgery; 19 exhibited incomplete dentition, with missing partial or whole posterior teeth; 26 suffered from obstruction at the ileum. A total of 51 bezoars were found in these patients, of whom 16 (45.7%) had multiple bezoars. CT planar scanning of bezoars showed lumps with mottled gas inside the intestinal cavity. Furthermore, 9 cases of bezoars had envelopes and 11 cases were accompanied with thickening of the distal wall of the obstructed bowel. Scanning of 17 cases was enhanced; the results revealed that the mesenteric blood vessels at the obstruction site and the proximal site were dilated, and a total of 7 cases were accompanied with distal vascular dilation and intestinal wall thickening.
CONCLUSION: BI-SBO exhibits regional and seasonal characteristics. CT planar and contrast-enhanced scanning can be applied to diagnose and observe vascular conditions in obstructed zones.
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Marchese S, Bertucci B, Manti F, Berritto D, Roperto AG, Tamburrini S. RECTAL IMPACTION DUE TO PRICKLY PEAR SEEDS BEZOAR: A CASE REPORT. J BIOL REG HOMEOS AG 2015; 29:707-711. [PMID: 26403411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Fecal impaction is the third cause of lower gastrointestinal tract obstruction after strictures for colon cancer and postoperative adhesions. A rapid diagnosis is necessary to avoid complications due to intestinal obstruction. Rectal phytobezoar due to prickly pear fruit seeds are an extremely rare entity, in the literature about twenty similar cases are described. Prickly pears are common in many countries, even in the Mediterranean area. When the ingestion of their fruit is excessive, this can be harmful, leading to the formation of phytobezoar causing fecal impaction. We describe the first case of phytobezoar due to prickly pear fruit seeds in continental Europe: a 76-year-old Italian female who ingested almost 40 prickly pear fruit leading to the composition of a large rectal phytobezoar. The patient presented clinically with fecal impaction, diagnosed by imaging and successfully treated by rectal irrigation and manual disimpaction. Our aim is to remind the physicians of these risks in evaluating patients with intestinal obstruction, when there is positive anamnesis for provenience from some areas in which these fruits are eaten. We also want to underline the role of Imaging Multi Detector Computed Tomography (MDCT) in the diagnosis of these very uncommon entities.
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Affiliation(s)
- S Marchese
- Department of Experimental and Clinical Medicine-Radiology, University of Catanzaro, Catanzaro, Italy
| | - B Bertucci
- Department of Experimental and Clinical Medicine-Radiology, University of Catanzaro, Catanzaro, Italy
| | - F Manti
- Department of Experimental and Clinical Medicine-Radiology, University of Catanzaro, Catanzaro, Italy
| | - D Berritto
- Department of Radiology, Second University of Naples, Naples, Italy
| | - A G Roperto
- Department of Radiology, Second University of Naples, Naples, Italy
| | - S Tamburrini
- Department of Radiology, Pellegrini Hospital, Naples, Italy
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