Bezoar Formation Research Articles

A CASE OF SMALL-BOWEL OBSTRUCTION DUE TO A GASTRIC BEZOAR

Small-bowel obstruciton due to gastric bezoar is rare. This case was a 73-year-old gastrectomized woman who was admitted with nausea and abdominal pain and was suspected of having acute pancreatitis. She ate a lot of persimmons several days before the onset of her symptoms and was diagnosed as having gastric bezoar by gastrofiberscopy. Three weeks later severe abdominal pain and distension appeared abruptly. An upper gastrointestinal contrast series demonstrated small-bowel obstruction with a bezoar and emergent operation was performed. A hen-egg-sized bezoar was impacted in the jejunum 30 cm distal from Treitz's ligament. It was removed through enterotomy.Fifteen cases of small-bowel obstruction due to gastric bezoars including this case have been reported during the last 10 years. In all cases conservative treatment failed and laparotomy was necessary. In gastrectomized patients like this case, it is probable that dislodgement of gastric bezoars caused small-bowel obstruction. Therefore, prophylactic measures such as dietary to prevent bezoar formation are important.

Association of Diabetes Mellitus With Gastric Bezoar Formation

The association of diabetes mellitus with gastric bezoars is not well documented. Our endoscopic experience over a seven-year period (1979 to 1985) included 3247 esophagoduodenoscopies (EGDs). Bezoars were found in 14 patients (0.4%). The mean age of these 14 patients was 63 years (range, 27 to 84 years); there were eight men and six women. In 11 patients, there was a history and/or findings of peptic ulcer disease (PUD). Two patients had prior surgery (Billroth II in one and vagotomy in another). Seven patients had diabetes mellitus; five had diabetes for over five years, and three of these five had diabetes for over ten years. Diabetes was newly diagnosed in one patient. Except for the newly diagnosed patient, the other diabetic patients had evidence of autonomic neuropathy. Two other patients (not included with the diabetic patients) had hyperglycemia only during stress. The three patients with bezoars but without PUD all had diabetes for many years (9, 17, and 19 years). In two control groups of 14 patients each who also underwent endoscopy, only one diabetic patient was discovered. We conclude that diabetes mellitus and associated gastropathy are major risk factors for bezoar formation, especially in the absence of PUD.

Bezoars—when the ‘knot in the stomach’ is real

Bezoars, gastric or intestinal concretions of undigested fruit fibers, vegetable matter, or human hair, can cause acute obstruction or long-term interference with normal digestion and absorption of nutrients. Likelihood of bezoar formation is increased in patients who have undergone gastrointestinal surgery. In particular, patients who have had gastric reduction for morbid obesity may form a high-risk population. Certain diseases or medicines also can predispose to bezoar formation. Except in emergencies, when surgical removal is necessary, dissolution of bezoars by various enzymatic preparations is the currently accepted treatment.

Postgastrectomy phytobezoars--endoscopic diagnosis and treatment.

Thirty-three consecutive patients with 38 bezoars were identified since 1975. Twenty-nine patients (87.8%) had undergone previous gastric surgery. The average interval between surgery and bezoar diagnosis was 7.7 years. There were 14 men and 19 women (mean age, 61.5 years). Epigastric distress (84%) and weight loss (31%) were the most common complaints. Twenty-two (75.9%) of 29 barium studies were falsely negative. Attempts at prior enzymatic dissolution had failed in three patients. Three (13.6%) of 22 patients available for follow-up had multiple episodes of bezoar formation. All patients underwent esophagogastroduodenoscopy for diagnosis and concomitant fragmentation and "flushing" of the bezoar for resolution. The success rate was 100%; no complications occurred.

Evaluation and Treatment of Urinary Candidiasis

The incidence of genitourinary fungal infections is increasing, and because of their lethal potential, early diagnosis and treatment is mandatory. Candida is the most common urinary fungus and is manifest as renal involvement from systemic candidiasis, primary renal candidiasis, bezoar formation, cystitis, and as asymptomatic candiduria. The clinical status of the patient, serial urine cultures, excretory urogram, and serum candidal titers help to differentiate between the various disease states. Treatment is specific and is based on the clinical manifestation of the disease. Systemic candidiasis is treated with intravenous amphotericin. Fungal bezoars are best treated with oral flucytosine, ureteral and renal irrigation with amphotericin and, occasionally, operation. Cystitis is treated with oral flucytosine or amphoteric bladder irrigations. Asymptomatic candiduria is left untreated. A systematized evaluation and treatment regimen is presented.

Gastric bezoars. A technique of endoscopic removal.

Gastric bezoar formation is an uncommon sequela of gastroduodenal surgery or unusual eating habits. Because they generally produce severe symptoms, their removal is always necessary. Previously, this required surgical extirpation or slow enzymatic dissolution. We present here an endoscopic procedure for bezoar removal utilized successfully in five patients with vegetable-mucus bezoars. This technique employs a jet spray of water under direct vision to mechanically disrupt the bezoar, which may then be removed using a large gastric lavage tube. This procedure is simple, safe, and rapid and is therefore recommended as an alternative to surgical removal or enzymatic dissolution of gastric bezoars.

Intestinal Obstruction From Medication Bezoars

MEDICATION bezoars are an unusual cause of intestinal obstruction. In two previous reports from this institution,^1,2six cases of patients with intestinal obstruction due to aluminum hydroxide gel or aluminum hydroxide gel and polystyrene sodium sulfonate (Kayexalate) bezoars were reported. Half the patients were adults with acute renal failure, and half were children who had undergone renal transplantation. Aluminum hydroxide gel was given for phosphate binding and as an antacid, and the polystyrene sodium sulfonate was used as an intestinal ionexchange resin for potassium control. Bezoar formation from the medications was potentiated by the lack of intestinal activity and the intermittent relative dehydration from dialysis for the renal failure. <h3>Report of Cases</h3><h3>CASE 1.—</h3> On April 22, 1977, a 32-year-old man received burns over 83% of his body surface area during an industrial flash fire. After five days of treatment at a local hospital, he was transferred to the

Bronchial Carcinoma With Autovagotomy and Bezoar Formation

AUTOVAGOTOMY, except as a manifestation of diabetic autonomic neuropathy, is a rare occurrence. Esophageal carcinoma causing autovagotomy and gastric bezoar has been recorded.1The present communication concerns the association of bronchial carcinoma with autovagotomy, gastric outlet obstruction, and bezoar formation. Report of a Case A 54-year-old man was hospitalized for recurrent pneumonia of the left side. During the previous six months he had experienced dysphagia, hemoptysis, anorexia, and an 18-kg weight loss. A chest roentgenogram showed a persistent infiltrate in the lingula and the superior segment of the left lower lobe. Bronchial cytology and biopsy specimens showed atypical squamous metaplasia. An upper gastrointestinal tract x-ray film showed a midesophageal stricture caused by an extrinsic lesion (Fig 1), an atonic stomach with gastric outlet obstruction, and a large intragastric mass simulating an extensive fundal carcinoma (Fig 2). A second film, taken after carbon dioxide producing tablets had been ingested to

Yeast bezoar formation following gastric surgery.

Yeast bezoar seems to be a relatively common late complication after various gastric operations. The incidence of bezoar depends decisively on the nature of the operation. Vagotomy in particular is conducive to the formation of a bezoar. Vagotomy + Billroth I resection proveded the most propitious conditions for the growth of yeast, for every one-half of the patients in this group developed a bezoar. Yeast bezoars usually appear within a year of the operation. The majority disappear during the first follow-up year, many without any therapy. However, in some cases the bezoar was a rather inconvenient late complication of gastric surgery and one that gave symptoms. It is difficult to draw any definite conclusions concerning the effect of therapy on the disappearance of the bezoar. We used gastric lavage and antimycotics as well as substances that increase gastric acidity. There is still no known method of preventing the formation of yeast bezoars. In the present consensus, a change in the acid conditions and disturbed gastric motility postoperatively are conducive to the formation of a bezoar.

Phytobezoar Occurring as a Complication of Gastric Carcinoma

Phytobezoar occurring as a complication of gastric carcinoma is reported for the first time. A review of the pathogenesis of phytobezoar suggests that hypomotility and hyposecretion are the two most important factors in bezoar formation. In the case discussed, hypomotility as a consequence of neoplastic involvement of the gastric antrum was the most important precipitating factor. However, documentation of prior hyposecretion was also noted and suggests that a combination of these two factors may be more significant than each taken alone. The therapeutic management of bezoars in patients who are not candidates for surgery is frequently difficult. This is the third case in which the enzyme cellulase has been used successfully for bezoar dissolution.

Bezoar following gastrectomy.

An intragastric grape phytobezoar occurred 1 month after hemigastrectomy, duodenostomy, and vagotomy. Bezoar formation was believed due to a combination of reduced proteolytic enzyme activity, faulty mixing, gastric stasis, and impaired mastication. Medical therapy with oral proteolytic enzymes and gastric lavage resulted in the complete disappearance of the bezoar, as demonstrated both roentgenographically and gastroscopically.

Mucus Bezoar with Partial Gastric Obstruction

Summary A case report of partial gastric obstruction caused by antral polyposis is presented. Serial gastroscopic examinations established the diagnosis of obstruction with mucus bezoar formation.