Large Bezoar Research Articles

Giant gastric and duodenal trichobezoar

A 10-year-old girl was admitted with abdominal pain and vomiting that had started 2 weeks earlier, following weight loss during the previous 3 months. She had a 2-year history of ingesting hair and carpet fibers (trichophagia). On examination, a firm mass was palpable in the upper abdomen. Sonography revealed a voluminous and heterogeneous formation within the stomach. Upper gastrointestinal endoscopy showed a large bezoar occupying the entire stomach (Figure [1 ] a, b) and extending into the duodenum (Figure [1 ] c), making passage of the endoscope difficult. A few attempts were made to remove it endoscopically, using forceps and a snare, but these were unsuccessful. The trichobezoar was then surgically removed by gastrotomy. It measured 14 × 8 cm and had almost completely occluded the stomach and duodenum (Figure [2]). The girl had an uneventful postoperative course and was referred to a psychiatrist.

Endoscopic Diagnosis and Treatment of Late Complications of Gastric Bandage

Background: Gastric bandage became a standard surgical procedure for treatment of morbid obesity. However, up to 15% of patients develop complications several months or even years after operation. Whenever possible, endoscopic diagnosis and treatment should be the method of choice. Methods: Late complications of gastric bandage include dilatation of proximal gastric pouch, slippage of the pouch, migration of the bandage through the gastric wall into the stomach, gastric ulcers, infections of bandage system, or its mechanical damage. We performed a retrospective assessment of late complications after gastric bandage, and evaluation of utility of upper endoscopy for making correct diagnosis and treatment of such complications. Results: Between January 1998 and October 2005, 32 patients (i.e. 3.9% out of 811 patients operated on in our center) with gastric bandage were sent to our endoscopic unit to perform upper endoscopy due to their acute or chronic complaints. Most of them had nauzea and vomiting, remaining had epigastric pain after meal or without association with meal. All of them underwent upper endoscopy with following findings: 24 pts had dilatation and/or slippage of the pouch, 3 pts were diagnosed with complete or partial migration of the bandage into the stomach, and 1 had a large bezoar formed by coconut. Remaining 4 pts had normal findings. Among patients with dilatation or slippage, in 19 out of 20 cases, the endoscopic examination of entire stomach (including distal part below the bandage) was possible. All cases were diagnosed correctly by endoscopy alone, in 3 patients the diagnosis of the dilatation or slippage was misdiagnosed by previous X-ray examination. Patients with migrating bandage were treated by combination of upper endoscopy plus laparoscopy (1 case), and by endoscopy alone (2 cases), where the migrated bandage was cut by endoscopical scissors. Patient with coconut bezoar in gastric pouch was treated by upper endoscopy followed by surgical removing of the bandage. Conclusions: Upper endoscopy is a usefull method for diagnosing most complications that occur after gastric bandage placement. Some complications my even be treated endoscopically or with endoscopic assistance.

Enterocutaneous fistula complicating a duodenal bezoar: an unusual presentation

View Large Image Figure ViewerDownload (PPT)View Large Image Figure ViewerDownload (PPT)View Large Image Figure ViewerDownload (PPT)View Large Image Figure ViewerDownload (PPT)A 76-year-old woman presented with dyspepsia, nausea, epigastric pain, and watery to purulent discharge from a small opening localized over an old hydatid cyst surgery scar at midline, about 5 cm above the umbilicus. CT of the abdomen revealed an open wound in the upper abdomen centrally (A, arrowhead), with an underlying large hypodense area extending to the gallbladder fossa and containing an irregular 2.5-cm calcification (A, arrow). A fistulogram outlined a large enterocutaneous fistula (B, arrowhead) communicating with the apex of a distended duodenal bulb that contained an irregular, large, filling defect (B, arrow). EGD showed a large, stony, hard bezoar occupying the duodenal bulb; the opening of the fistula was seen with minimal superficial ulceration (C and D). Exploratory laparotomy revealed perforation of the duodenum, which contained a large bezoar. Removal of the bezoar and primary closure of the duodenum then were performed. The bezoar consisted of a black-green, firm, ovoid structure that measured 4.5 × 3.5 × 1.5 cm and weighed 230 g (E). Two weeks after surgery, upper-GI series showed normal opacification of the GI tract, with complete closure of the previously described duodenocutaneous fistula. View Large Image Figure ViewerDownload (PPT)View Large Image Figure ViewerDownload (PPT)View Large Image Figure ViewerDownload (PPT)

Laparoscopic removal of a large gastric bezoar in a mentally retarded patient with pica

Whereas small gastric bezoars may be removed endoscopically, large bezoars traditionally are removed at laparotomy. We describe a 33-year-old mentally retarded woman with pica syndrome who had experienced episodes of upper abdominal pain and distension of 10 months duration. Gastroscopy showed a large bezoar in the stomach, and attempted endoscopic removal was unsuccessful. The patient underwent laparoscopic extraction of the bezoar, which proved to be an ingested glove. She made an uneventful recovery and was discharged home on postoperative day 1. She had no wound complications, and her symptoms had not recurred at a 3-month follow up assessment. The operative technique is described, and the merits of the laparoscopic approach are discussed.

GIANT GASTRIC TRICHOBEZOAR

SUMMARYBezoars are relatively common foreign body lesions of the stomach and intestine. Small bezoars can be treated using non‐surgical methods, but large bezoars usually require open surgery. Occasionally they are giant‐sized and may mimic an intra‐abdominal mass clinically. We present the case of a 24‐year‐old woman with a giant gastric trichobezoar treated by open surgery; treatment methods are discussed.

Conservative Management of Ingested Foreign Bodies

We reviewed the clinical benefits of hospitalization, esophagogastroduodenoscopy, and surgical intervention for ingested foreign bodies in adults. Patients with esophageal foreign bodies were not included in the study group. A 10-year experience is reported. Each patient's physical examination findings at presentation, white blood cell count, length of hospital stay, number and types of foreign bodies ingested, endoscopic interventions, surgical interventions, and complications were reviewed. There were 75 separate hospitalizations, all occurring in 22 male prison inmates. A total of 256 foreign bodies were ingested. Patients incurred 281 hospitalization days (average 3.7 days per admission). One patient had signs of peritonitis. White blood cell count was less than 10 K/μL in 85%. Sixty-four endoscopies were performed with removal of 79 of 163 foreign bodies (48% success rate). Five patients required general anesthesia because of a lack of cooperation. Complications occurred in four of them, one requiring laparotomy. Eight additional laparotomies were performed. One was performed for an acute abdomen on admission and one for the development of an acute abdomen after conservative management. Two were performed to remove metal bezoars. Four additional laparotomies were performed because of surgeon preference. Among the 23 patients admitted and managed conservatively, 77 (97%) of 79 foreign bodies passed spontaneously. One patient required laparotomy. Of the 256 ingested foreign bodies, 79 were removed endoscopically, 71 were removed surgically, and 106 passed spontaneously. The size, shape, and number were not predictive of the ability to transit the gastrointestinal tract. Foreign body ingestion is problematic in prison inmates. With conservative management, most foreign bodies will pass spontaneously. Endoscopy has a high failure rate and is associated with significant complications. Surgical intervention should be reserved for those who have acute conditions in the abdomen or large bezoars. ( J Gastrointest Surg 2002; 6:496–500.)

An experimental study and clinical applications of breaking gastric bezoars endoscopically by a laser ignited mini-explosive head

This paper reports the successful experimental studies of a laser detonating a mini-explosive head to break stones in vitro and in vivo. This technique has been used clinically with gastric bezoars since January 1988. All 31 patients were completely cured without complications. The relationship between gastric bezoars and ulcers and the treatment technique are also discussed in this paper. Diospyrobezoar is one of the common bezoars in the persimmon producing regions. This disease has been reported in many countries including our own, but until now there has been no effective treatment for large gastric bezoars except by surgery. To develop a better treatment for this problem the laser ignited mini-explosion technique to break large bezoars in vitro and in vivo was begun in October 1986 and first successfully applied clinically in January 1988.