3247 Don't Clean the Stomach With a Kitchen Sponge: Case of a Kitchen Sponge Presenting as a Gastric Bezoar

Abstract

INTRODUCTION: Gastric bezoars are rare and caused by ingestion of indigestible material. They are called polybezoars if resulted from the accumulation of ingested foreign bodies in the stomach. We present a rare case of a gastric polybezoar secondary to the ingestion of a kitchen sponge in a 53-year-old female which presented a significant endoscopic challenge during the removal. CASE DESCRIPTION/METHODS: A 53-year-old female with a history of major depressive disorder and multiple abdominal surgeries including gastric bypass was admitted for abdominal pain and vomiting for the last three days. Physical exam was remarkable for abdominal scars from prior surgeries. Initial laboratory data showed elevated blood urea nitrogen and creatinine. CT abdomen showed evidence of gastric bypass with a foreign body in the gastric remnant without any intestinal obstruction. On further questioning, she revealed that she had ingested the pieces of a kitchen sponge one week ago. An upper endoscopy was done which revealed an eight cm polybezoar made up of food material coating a sponge in the gastric pouch. The bezoar was fragmented using the biopsy forceps and removal was accomplished using Roth net and Trapezoid basket. An over tube was used to facilitate the repeated passages of the scope. The procedure lasted for two hours thus presenting a significant challenge. DISCUSSION: A gastric bezoar is defined as a foreign body resulting from the accumulation of ingested material in the stomach. It is a rare condition with the incidence of 0.4-4%. Depending on the type of the ingested material, it can be a phytobezoar (fibers), a trichobezoar (hair), a pharmacobezoar (medications), a polybezoar (foreign body) or a lactobezoar (milk product). Stomach is the most common site involved. Most bezoars are clinically asymptomatic due to large capacity of the stomach and are diagnosed incidentally on imaging or endoscopy done for other reasons. When symptomatic, they may present with epigastric pain, vomiting, hematemesis or small bowel obstruction. The major risk factors for the formation of the bezoars are conditions associated with gastric dysmotility, previous gastric surgery and psychiatric disorders. Complicated gastric bezoars impose a great challenge to an endoscopist. Several modalities have been suggested for the management of bezoar including chemical dissolution (sodium bicarbonate, Coca Cola lavage etc.) and endoscopic fragmentation with removal. Surgery is reserved for intestinal obstruction or a failed endoscopic treatment.