Gastric Phytobezoar Research Articles

Tennis ball cord combined with endoscopy for giant gastric phytobezoar: A case report

BACKGROUND Due to the specificity of Chinese food types, gastric phytobezoars are relatively common in China. Most gastric phytobezoars can be removed by chemical enzyme lysis and endoscopic fragmentation, but the treatment for large phytobezoars is limited, and surgical procedures are often required for this difficult problem. CASE SUMMARY For giant gastric phytobezoars that cannot be dissolved and fragmented by conventional treatment, we have invented a new lithotripsy technique (tennis ball cord combined with endoscopy) for these phytobezoars. This non-interventional treatment was successful in a patient whose abdominal pain was immediately relieved, and the gastroscope-induced ulcer healed well 3 d after lithotripsy. The patient was followed-up for 8 wk postoperatively and showed no discomfort such as abdominal pain. CONCLUSION The combination of tennis ball cord and endoscopy for the treatment of giant gastric phytobezoars is feasible and showed high safety and effectiveness, and can be widely applied in hospitals of all sizes.

Endoscopic treatment of a large gastric bezoar: A Case report

Bezoars are concretions of undigested or partially digested foreign material in the gastrointestinal tract. They occur in patients with altered gastrointestinal motility or anatomy (previous gastricsurgery, diabetes mellitus, neurological disorders). They are rare, with an estimated %0.3 on upper endoscopy. The most common symptoms include abdominal pain, nausea, vomiting, early satiety, anorexia, and weight loss. We present a patient who diagnosed with 8-9 cm phytobezoar, and treated by endoscopic method. An 87 years old woman presented to our emergency room with upper abdominal pain, nausea, and postprandial emesis for 3 days. Emergency esophagogastroduodenoscopy revealed prepyloric antrum, gastric phytobezoar (8-9 cm) and ulcers (10-12 mm). We used an endoscopic snare to cut the bezoar into several pieces. After endoscopy, all bezoars disappeared. There was no recurrence during 1-year follow-up. In conclusion, endoscopic treatment may be a safe and viable option for the extraction of gastric bezoars presenting with gastric outlet obstruction. This is the rare case that such a large phytobezoar (8×9 cm) has been fragmented with an ordinary polypectomy snare.

Acute Cholecystitis Masking a Gastric Bezoar

A bezoar is a solid mass of indigestible material that usually forms in the gastrointestinal (GI) tract. Gastric bezoars, located in the stomach, can present variably. They can be asymptomatic or present with GI symptoms like nausea, vomiting, abdominal pain, or more serious complications, such as GI obstruction or perforation. Diagnostic modalities are mainly radiological, and treatment may either be conservative or interventional. Herein, we disclose the case of a 47-year-old female who presented with a two-week history of abdominal pain with an incidental finding of a possible gastric phytobezoar, co-existing with gallbladder disease. Although not previously reported, this study highlights the possibility of an association between gallbladder disease and the formation of a bezoar.

A rare case report of late-onset phytobezoar formation following laparoscopic sleeve gastrectomy: delayed redo bariatric surgery

BackgroundPhytobezoar formation is a complication of bariatric surgery and mostly occurs after laparoscopic Roux-en-Y gastric bypass (LRYGB) operations. Here, we present an extremely rare case of late phytobezoar formation following laparoscopic sleeve gastrectomy (LSG).Case presentation A 52-year-old woman with a body mass index (BMI) of 40.7 kg/m2 underwent LSG. Following persistent symptoms of nausea, vomiting, early satiety, and tremendous weight loss, endoscopy was performed, and gastric phytobezoar was detected at one-year post-operation. After endoscopic fragmentation, phytobezoar was removed by snare, and the patient later underwent redo bariatric surgery (conversion of LSG to LRYGB).ConclusionsWith an increase in the number of LSG procedures performed globally, and the late-onset nature of phytobezoar formation, more cases of this complication are expected to be detected in future. Long-term postoperative follow-up alongside applying surgical methods to avoid gastric stenosis are needed to reduce the chance of phytobezoar formation in patients undergoing LSG.

S2910 Symptomatic Gastrointestinal Amyloidosis in a Patient With Systemic AL Amyloidosis

INTRODUCTION: Gastrointestinal (GI) amyloidosis is a rare protein deposition disorder that can be limited to the GI tract but is most often a manifestation of systemic amyloidosis. While it can be asymptomatic, typical presentations include dysmotility, malabsorption, bleeding and protein-losing gastroenteropathy. GI amyloidosis is most commonly in the esophagus, duodenum, stomach and rectum. The diagnostic gold standard is tissue biopsy with positive Congo red staining, usually from the rectum (sensitivity, 75-85%) or duodenum. CASE DESCRIPTION/METHODS: A 57-year-old woman with systemic amyloid light-chain (AL) amyloidosis complicated by restrictive cardiomyopathy, heart failure and junctional bradycardia requiring a pacemaker, and treated with bortezomib and dexamethasone with good response, presented to the hospital with recurrent constipation, nausea, vomiting and abdominal discomfort. Abdominal radiographs and CT scan demonstrated dilation of the cecum to 7.9 cm, concerning for ileus, but no obstruction (Figure 1). She was diagnosed with likely colonic pseudoobstruction, treated with neostigmine, and discharged on a regimen of antiemetics and prokinetics. Soon after, she was re-admitted with rectal bleeding; colonoscopy showed normal-appearing mucosa and polyps (Figure 2), with a large hemorrhoid as the likely source. Subsequently, she was re-admitted for a heart failure exacerbation; she was considered for heart transplant as her disease was believed to be in remission but had persistent poor oral intake, nausea and constipation. Endoscopy was notable for a gastric phytobezoar and duodenal ulcers; gastric, duodenal and rectal biopsies with Congo red stain confirmed the diagnosis of GI amyloidosis. She was started on ixazomib and dexamethasone, with improved GI symptoms and only mild dysmotility seen on a gastric emptying study, and is pursuing heart transplantation. DISCUSSION: GI amyloidosis is rare but has important clinical and prognostic implications. Our patient presented with a range of vague GI symptoms and non-specific radiographic and gross endoscopic findings. Maintaining a high index of suspicion and obtaining mucosal biopsies with Congo red staining early in the course avoids delay in diagnosis and symptom progression. Upon diagnosis of GI amyloidosis, this patient was treated with chemotherapy, which targeted the underlying cause of her GI symptoms, resulting in sufficient improvement. In this case, the patient’s diagnosis of GI amyloidosis was key to her consideration for cardiac transplant.Figure 1.: Abdominal radiograph showing increased gaseous distension of the colon compatible with ileus. No evidence of obstruction.Figure 2.: Colonoscopy showing normal appearing mucosa and multiple polyps in the descending colon.

Magic of Coca-Cola: A Case Presentation and Management of Gastric Outlet Obstruction Caused by Gastric Phytobezoar

Magic of Coca-Cola: A Case Presentation and Management of Gastric Outlet Obstruction Caused by Gastric Phytobezoar

Phytobezoar: a rare late complication following laparoscopic sleeve gastrectomy surgery

Case reports of bezoar after bariatric surgery are available to date only following Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB), but not following laparoscopic sleeve gastrectomy (LSG). Presented here is the first case reports of phytobezoars occurrence post LSG. Two case reports are presented. The mechanisms involved and the therapeutic implications are discussed. Case 1: A 41-year-old woman with a body mass index (BMI) of 45 kg/m2 underwent LSG surgery. Seven months postoperatively she developed significant vomiting and an upper GI gastrografin swallow study revealed a gastric bezoar, confirmed by an esophagogastroduodenoscopy (EGD). The bezoar was broken up and removed with the endoscope. Case 2: A 34-year-old woman with initial BMI of 42.7 kg/m2 was readmitted 5 years post LSG due to reflux accompanied with epigastric pain, vomiting, dysphagia and constipation. An upper GI gastrografin swallow study revealed esophageal dilatation. EGD showed a gastric phytobezoar 3x4cm size, removed by the endoscope. The lack of reports on bezoar occurrence after LSG may be related to the higher rates of stricture reported for LRYGB procedure comparing to LSG. In addition, LSG is a relatively new bariatric procedure, and the interval between surgery and detection of bezoars may be many years later. Thus, even being a rare late complication, bezoars should be suspected in LSG patients presenting with obstructive symptoms during the late post-surgery period. We recommend prompt endoscopic intervention to relieve the obstruction before parts of the bezoar migrate to the small bowel, necessitating operative intervention

Gastric outlet and duodenal/ileal obstruction due to gastric phytobezoar

We herein present the case of an 83-year-old man, ASA status III, with a fragmented gastric phytobezoar causing obstruction in different parts of the gastrointestinal tract. The initial mass was obviously in the stomach, and due to continuing coughing and vomiting the bezoar was fragmented. The apex of the bezoar moved through the deformed pyloric channel, temporarily occluding first the duodenojejunal flexure and afterwards the ileus, while the larger remnants repeatedly sealed off causing gastric outlet obstruction. At emergent laparotomy, a gastrojejunostomy was created through which both bezoars were extracted, and the operation was completed with a vagotomy. The patient had an uneventful postoperative outcome and is doing well at 12-month follow-up. Complicated bezoars require emergent surgical removal.

Gastric Diospyrobezoar Mimicked Acute Appendicitis: A Case Report

A phytobezoar is a concreted mass of undigested plant materials trapped in the gastrointestinal system and mostly in the stomach. A diospyrobezoar is a type of phytobezoar and is a rare condition; it is due to unripe persimmon ingestion. In this case, report, we recount the experience of a 26-year-old man who presented signs and symptoms of acute appendicitis, which was later diagnosed as a gastric diospyrobezoar. An appendectomy was done, but the symptoms were not resolved. This gastric phytobezoar was suc- cessfully removed through gastrotomy after a failed attempt in endoscopic fragmentation and removal. This report provides an overview of bezoars in patients with acute abdominal pain. A careful history with an emphasis on recent diet can be of great help in the diagnosis of similar cases.

Each worm to his taste: some prefer to eat nettles - a giant gastric phytobezoar.

Key Clinical MessageNettle consumption, as well as persimmon, orange, coconut etc. can lead to phytobezoar formation. Coke and cellulase‐resistant phytobezoars should be removed either endoscopically or surgically, depending on their dimensions. The treatment of choice for giant phytobezoars (more than 10 cm) is gastrotomy.

Laparoscopic Extraction of a Gastric Phytobezoar: A Different Approach.

To the Editor, There are many therapeutic modalities for managing gastric bezoars. These include nasogastric lavage or suction, enzymatic therapy, the use of prokinetic agents and gastroscopic fragmentation and extraction (1–3). If these non-operative treatments fail, a surgical approach is needed and removal of the bezoar has classically been performed by gastrotomy. To our knowledge there are few articles about the laparoscopic treatment of gastric bezoars (1–5). A 54-year-old-female was admitted with severe abdominal pain, loss of appetite and with having had feelings of ‘a moving object’ in the stomach for a year. Gastroscopy demonstrated a hard phytobezoar of approximately 7 × 5 cm in size with-in the stomach that could not be fragmented using endoscopic techniques. Therefore laparoscopic removal was considered. First, the gastrocolic ligament was cut approximately 6–7 cm along the stomach (Figure 1). Then the bezoar was removed via a gastrotomy from the greater curvature using the three-trocar technique (Figure 1). It was successfully retrieved from the abdominal cavity after having been fragmented within an endobag (Figure 2). After the extraction, the gastric incision site was closed using two staplers (Tri-Staple 60, Covidien). Finally, the gastrocolic ligament was closed using continuous sutures, and a drainage tube was inserted near the gastrotomy site. The pathologic diagnosis was gastric phytobezoar. All the patient’s complaints were gone and the wound healed 2 weeks after the operation. FIG. 1. Gastrotomy line in the greater curvature (straight stripe), opened gastrocolic ligament (big arrow), posterior wall of the stomach (small arrow) FIG. 2. Extraction of phtyobezoar from the stomach Herein we presented a laparoscopic treatment of a gastric phytobezoar. Our approach was unique because we made a gastric incision in the greater curvature, which we think this is much more anatomically effective than previously reported techniques, such as anterior wall incisions. This approach affects the natural shape of the stomach minimally and a minimal amount of gastric tissue is extracted (Figure 3). FIG. 3. The remains of the phtyobezoar and removed minimal gastric tissue after the surgery

Wernicke's Encephalopathy, Wet Beriberi, and Polyneuropathy in a Patient with Folate and Thiamine Deficiency Related to Gastric Phytobezoar.

Background. Wernicke's encephalopathy (WE) is an acute neurological disorder resulting from thiamine deficiency. It is mainly related to alcohol abuse but it can be associated with other conditions such as gastrointestinal disorders. This vitamin deficiency can also present with cardiovascular symptoms, called “wet beriberi.” Association with folate deficit worsens the clinical picture. Subject. A 70-year-old man with gastric phytobezoar presented with gait instability, dyspnoea, chest pain associated with right heart failure and pericarditis, and folate deficiency. Furosemide was administered and cardiac symptoms improved but he soon developed vertiginous syndrome, nystagmus, diplopia, dysmetria, and sensitive and motor deficit in all four limbs with areflexia. Results. A cerebral magnetic resonance imaging (MRI) showed typical findings of WE. He was immediately treated with thiamine. Neurological symptoms improved in a few days and abnormal signals disappeared in a follow-up MRI two weeks later. Conclusion. Patients with malabsorption due to gastrointestinal disorders have an increased risk of thiamine deficiency, and folate deficiency can make this vitamin malabsorption worse. An established deficiency mainly shows neurological symptoms, WE, or rarely cardiovascular symptoms, wet beriberi. Early vitamin treatment in symptomatic patients improves prognosis. We recommend administration of prophylactic multivitamins supplements in patients at risk as routine clinical practice.

Les abdomens chirurgicaux dus au traitement traditionnel. À propos de cinq cas au Centre hospitalier Yalgado Ouédraogo de Ouagadougou

The traditional products used to treat some pains can cause serious complications of which surgical abdomen. We listed in two years five cases of surgical abdomen complicating a traditional treatment in the service of digestive and general surgery of the hospital complex Yalgado Ouédraogo. There were two men and three women with an average age of 34,4 years. These traditional products were used to treat constipation, sexual impotence, sterility and to "posses" her husband. Oral and rectal routes were used by one and three patients respectively, another patient used triple routes (oral, rectal and vaginal). The digestive lesions were in the upper tract in one case (gastric phytobezoar), two patients presented acute intestinal occlusion and two others acute generalized peritonitis. All the five patients underwent laparotomy. Two patients died in immediately post-operative course. The prevention of severe surgical complications of the digestive tract induced by traditional treatments has to be broadcasted through information, education and communication.

Systematic review: Coca‐Cola can effectively dissolve gastric phytobezoars as a first‐line treatment

Gastric phytobezoars represent the most common bezoars in patients with poor gastric motility. A variety of dissolution therapies and endoscopic fragmentation techniques have been evaluated as conservative treatment so as to avoid surgery. To investigate the effectiveness of Coca-Cola for gastric phytobezoars dissolution. We performed a systematic search to identify publications on gastric phytobezoars to assess the efficacy of Coca-Cola as a dissolution therapy. Diospyrobezoars, formed after persimmon ingestion, are a distinct type of phytobezoars characterized by their hard consistency. Thus, these two subgroups of bezoars were compared in terms of successful dissolution. Over a 10-year period (2002-2012), 24 papers including 46 patients have been published. In 91.3% of the cases, phytobezoar resolution with Coca-Cola administration was successful, either as a single treatment (50%) or combined with further endoscopic techniques, whereas only 4 patients underwent surgery. Phytobezoars were more likely to dissolve after initial attempt with Coca-Cola compared with diospyrobezoars (60.6% vs. 23%, P=0.022). Coca-Cola alone is effective in gastric phytobezoar dissolution in half of the cases and, combined with additional endoscopic methods, is successful in more than 90% of them.

Treatment of gastric phytobezoars with Coca-Cola® given via oral route: a case report

BackgroundA 43-year-old female patient presented with a chief complaint of upper abdominal pain. As her complaints had lasted for 1 month, an upper gastrointestinal system endoscopy was performed and discovered a bezoar in the stomach.Case presentationThe bezoar was quite hard and light green-yellow in color. Pathological examination revealed phytobezoar. The patient was hospitalized and given oral Coca-Cola® Zero for seven days at a dose of 500 mL three times daily.ConclusionThe upper gastrointestinal system endoscopy performed at the end of 7 days showed that the phytobezoar had softened and become smaller. The phytobezoar was broken into pieces with biopsy forceps and washing was applied, so the phytobezoar pieces could pass through the pylorus. The patient was discharged after the procedure without problem.

Successful endoscopic resolution of a large gastric bezoar in a child

Bezoars are masses or concretions of indigestible materials found in the gastrointestinal tract, usually in the stomach. Case reports of childhood gastric bezoars (particularly phytobezoars) are rare. In this age group they represent a therapeutic challenge, because of the combination of hard consistency and great size. The present report concerns an 8-year-old boy with a history of high fruit intake, presenting with abdominal complaints due to a large gastric phytobezoar. Successful endoscopic fragmentation coupled with suction removal was accomplished, using a standard-channel endoscope. Although laborious, it has been shown to be an efficacious and safe procedure, completed in one session. Endoscopic techniques for pediatric bezoar management may thus be cost effective, taking into account the avoidance of surgery, the length of the hospital stay and the number of endoscopic sessions.

A case of gastric carcinoma which became a core of gastric phytobezoar

A case of gastric carcinoma which became a core of gastric phytobezoar

Cellulase treatment in 3 cases of large phytobezoars

IntroductionA bezoar is a hard mass of undigested foreign matter found in the gastrointestinal system. The most common type is the phytobezoar, which is composed of vegetable fibres. There is no current consensus as to its treatment. Three cases of phytobezoars treated with cellulase are described. Patients and methodCase 1: patient with large gastric phytobezoar. Initial treatment with nasogastric cola drink lavages was ineffective. Subsequent treatment with cellulase was successful. Case 2: patient with gastric phytobezoar who was treated with cellulase and metoclopramide. Definitive fragmentation was performed with the endoscopy technique. Case 3: patient with large intestinal phytobezoar. The patient was treated by endoscopic lysis with partial success. Subsequent treatment with cellulase led to complete disintegration. In all the cases, cellulase was administered in pure form by nasogastric tube, and none of the patients suffered adverse effects. ConclusionsTreatment with cellulase is based on the enzymatic degradation of the bezoar. It has been shown to be effective as the treatment of choice in earlier studies with few patients. This agent seems to be a good alternative for patients with large phytobezoars.

Huge gastric disopyrobezoar: A case report and review of literatures

We reported a case of huge gastric phytobezoar. The gastric phytobezoar was successfully removed through gastrotomy after two failed attempts in endoscopic fragmentation and removal. Disopyrobezoars could be treated either conservatively or surgically. Gastrotomy or laparoscopical management is recommended for the treatment of huge disopyrobezoars.

Laparoscopic Removal of Gastric Bezoar

Many approaches have been proposed for the treatment of bezoars, such as gastroscopic fragmentation, nasogastric lavage or suction, and enzymatic therapy. Because gastroscopic removal has not always been successful, especially in large gastric bezoars, surgical removal by gastrotomy through abdominal incision has been performed. With the advent of laparoscopic surgery, it became possible to remove such lesions without large abdominal incisions. In this case, we present a 62-year-old male who had gastric phytobezoar that was successfully treated with a laparoscopic technique.