• bezoar
• case report
• duodenum related cases
• gastric outlet obstruction (goo)
• gastrointestinal (gi)
• phytobezoar
• upper endoscopy

• Childhood nutrition
• Eating disorders
• Endoscopy
• Gastrointestinal surgery
• Impulse control disorders

• Drug lithotripsy
• Endoscopic lithotripsy
• Phytobezoar
• Sodium bicarbonate

• Humans
• Bezoars/therapy
• Male
• Female
• Lithotripsy/methods
• Aged
• Middle Aged
• Retrospective Studies
• Proton Pump Inhibitors/therapeutic use
• Proton Pump Inhibitors/administration & dosage
• Treatment Outcome
• Sodium Bicarbonate/administration & dosage
• Sodium Bicarbonate/therapeutic use
• Combined Modality Therapy
• Abdominal Pain/etiology
• Abdominal Pain/therapy

• traffic accident
• gastric perforation
• psychiatric disorders
• trichobezoar
• trichophagia

• Female
• Humans
• Young Adult
• Accidents, Traffic
• Bezoars/complications
• Bezoars/diagnostic imaging
• Bezoars/surgery
• Laparotomy/methods
• Tomography, X-Ray Computed

• adult
• bezoars
• chatgpt
• endoscopy
• intestinal obstruction
• rectal bezoar
• rectal diseases

• Acute pancreatitis
• computed tomography
• critical care
• duodenal bezoar
• esophagogastroduodenoscopy

Gastric bezoar is a concretion of undigested material found in the stomach and is classified by its composition. Patients may remain asymptomatic or present with a variety of gastrointestinal symptoms. Upper gastrointestinal endoscopy is required to establish the diagnosis. Treatment options include chemical dissolution, endoscopic removal, or surgical removal. Here, we present a rare case of gastric bezoar in a patient with a remote history of bariatric surgery presenting with acute weight loss.

• Rapunzel syndrome
• bezoar
• gastroenterology
• general surgery
• trichobezoar

Purpose: To describe our experience with phytobezoars, evaluate risk factors on treatment, and analyze whether previous gastric surgery affects treatment outcomes.

Methods: Medical records of 51 patients with phytobezoars between 2000 and 2019 were retrospectively evaluated. We compared endoscopic and surgical treatment groups and evaluated risk factors using multivariate logistic regression analysis. And we compared patients with and without previous gastric surgery in the surgical treatment group.

Results: The median patient age was 62.9 (range: 27–89) years. The endoscopic and surgical treatment groups included 26 (51%) and 25 (49%) patients, respectively. Patients aged ≥65 years, diabetes, and small intestinal phytobezoars were more frequent in the surgical treatment group. Previous gastric surgery (n = 16, 31.4%) was the most common predisposing risk factor, but without a significant difference between the groups. Enterotomy was performed for 20 patients (80%), segmental resection was performed for five patients (20%). Five patients (20%) had postoperative complications; there was one death. There were no significant differences in age, preoperative diagnosis, operation method, operative time, or postoperative stay between patients with and without previous gastric surgery, but postoperative complications were significantly more common in patients with previous gastric surgery.

Conclusions: Phytobezoar should be suspected early in patients with previous gastric surgery or a specific food intake history. Early diagnosis and treatment are important for avoiding surgical intervention and complications, especially in elderly patients. Surgery is required in most patients with small intestinal phytobezoars, safe removal can be achieved mainly via enterotomy.

• bezoars
• endoscopy
• gastric surgery
• intestinal obstruction
• surgery

Intestinal obstruction considered to be one of the most common surgical presentation. Adhesions secondary to previous operations, hernias, neoplasms, inflammatory bowel disease, intussusception, or volvulus are the usual causes of intestinal obstruction but bezoar can presents in 0.4-4%. Bezoar can be trapped in different locations throughout the gastrointestinal tract and it can be solitary or multiple lesions.

This is a 37-year-old male, known case of diabetes mellitus, Presented to the Emergency Department complaining of generalized abdominal pain for 2 days duration. Associated with abdominal distention, fever, nausea, vomiting and obstipation. There was a history of persimmon intake. Unremarkable past surgical history. On examination, He was tachycardic, other vital signs were within normal. Abdominal examination showed abdominal distention and Sluggish bowel sound. Abdominal X-ray revealed multiple air-fluid levels. An abdominal CT scan with IV contrast revealed an intra-luminal mass in the ileum and intra-gastric mass with suspicious of bezoars. He underwent exploratory laparotomy, gastrostomy to remove intra-gastric bezoar, and enterotomy to remove the ileal bezoar.

Intestinal obstruction is considered to be the most common complication of this entity; other possible complications include gastric ulcer, gastritis, and gastric perforation. Due to limitations of endoscopy and barium enema in the diagnosis of bezoar, Abdominal CT-scan is considered to be the gold standard in the diagnosis. The management of phytobezoar can be either conservative or surgical, depends on the lesion size and location.

Although intestinal obstruction secondary to bezoar is rare, multiple levels of gastrointestinal obstruction should raise the suspicion of bezoar.

•

Bezoar can be trapped in different locations throughout the gastrointestinal tract and it can be solitary or multiple lesions.

• Bezoar
• Enterotomy
• Gastrostomy
• Persimmon
• Phytobezoars

•

Phytobezoar is described as an impacted indigested or incompletely digested vegetable and fruit fibers.

Phytobezoar which is described as an undigested or incompletely digested food. It is an odd cause of gastric outlet obstruction (GOO). The aim of this study is to present and discuss a case of GOO caused by multiple giant bezoars.

A 24-year-old female, presented with abdominal pain and vomiting (non-bilious) with negative past history. Examination and investigations revealed multiple giant bezoars requiring emergent surgical intervention. An exploratory laparotomy was conducted. Two giant bezoars were palpated in the stomach and removed through an anterior gastrotomy.

Bezoars are regarded as rare benign causes of GOO. Bezoars can present with vomiting, nausea, and/or symptoms of GOO. Predisposing risk factors include delayed gastric emptying (as in case of diabetic mellitus) vagotomy, partial gastrectomy pyloroplasty, peptic ulcer disease, chronic gastritis, Crohn’s disease, and carcinoma of the gastrointestinal tract. The current case had phytobezoar without any known risk factor.

GOO caused by phytobezoar can occur in patients without history of previous gastric surgery or diabetes mellitus. Urgent laparotomy may be indicated.

• Bezoar
• GOO
• Gastric outlet obstruction
• Gastrotomy
• Giant
• Phytobezoar

• Bowel obstruction
• Case report
• Gastrojejunostomy
• Phytobezoar
• Poor dentition
• Roux-en-y

BEZOARS are retained concretions of indigestible foreign material that accumulate and conglomerate in the gastrointestinal tract, most commonly in the stomach. Prevalence of bezoar is 0.4%. Bezoars are classified in four categories: phytobezoars; trichobezoars; pharmacobezoars; lactobezoars. A 58-year-old man admitted with complains of pain abdomen and recurrent vomiting since last 3 months. Upper GI endoscopic biopsy reported—chronic gastritis with very occasional non-caseating epitheloid granuloma in lamina propria, no evidence of neoplasia? Crohn’s disease. Keeping Crohn’s as diagnosis patient was given mesalamine 400 mg tid by gastrophyscian. But patient did not respond so the patient was advised surgical management. Repeat UGI endoscopy revealed multiple pills (mesalamine) in the stomach with gastric outlet obstruction (GOO). Around 40 pills were extracted with the help of flower basket, and then patient develope GOO and underwent Laparoscopic gastrojejunostomy and truncal vagotomy.

• abdomen
• acute
• bezoars
• intestinal obstruction

• bezoar
• bowel obstruction
• endoscopy

• Gastric bezoar
• Gastric outlet obstruction
• Gastric pneumatosis

A 52-year-old male patient with psychiatric medical history who presented to the emergency department five times during a period of 5 years due to gastric outlet obstruction manifested mainly by abdominal pain, vomiting and haematemesis after intentionally ingesting metals and which necessitate several surgical interventions. Lately, he presented with generalised peritonitis due to gastric perforation from metal bezoars. Chronic abdominal symptoms in patient having a psychiatric disorder can be due to foreign body ingestion. Treatment is often surgical and the whole digestive tract should be explored to avoid retained bezoars.

• eating disorders
• emergency medicine
• gastrointestinal surgery
• stomach and duodenum

• Endoscopy, Gastrointestinal
• Foreign Bodies
• Upper Gastrointestinal Tract

• Bezoars
• Critical care
• Enteral nutrition
• Gastrointestinal
• Intubation

• Abdomen
• Bezoars
• Gastric Outlet Obstruction
• Trichotillomania

• Bezoar
• Intestinal obstruction
• Persimmon

• Aged
• Bezoars/complications
• Bezoars/diagnosis
• Diagnosis, Differential
• Diospyros
• Female
• Humans
• Intestinal Obstruction/diagnostic imaging
• Intestinal Obstruction/etiology
• Intestine, Small/diagnostic imaging
• Radiography, Abdominal

• Bezoar
• Bowel obstruction
• Colon
• Peritonitis

• Endoscopy
• Extrahepatic
• Phytobezoar

Bezoars are concretions of indigestible materials in the gastrointestinal tract. It generally develops in patients with previous gastric surgery or patients with delayed gastric emptying. Cases of periampullary duodenal divericular bezoar are rare. Clinical manifestations by a bezoar vary from no symptom to acute abdominal syndrome depending on the location of the bezoar. Biliary obstruction or acute pancreatitis caused by a bezoar has been rarely reported. Small bowel obstruction by a bezoar is also rare, but it is a complication that requires surgery. This is a case of acute pancreatitis and subsequent duodenal obstruction caused by a large duodenal bezoar migrating from a periampullary diverticulum to the duodenal lumen, which mimicked pancreatic abscess or microperforation on abdominal computerized tomography. The patient underwent surgical removal of the bezoar and recovered completely.

• Bezoar
• Diverticulum
• Pancreatitis
• Duodenal obstruction

Phytobezoar, a concretion of indigestible fibers derived from ingested vegetables and fruits, is the most common type of bezoar. Diospyrobezoar is a subtype of phytobezoar formed after excessive intake of persimmons (Diospyros kaki). We report the case of a diabetic man with a 5-day history of abdominal pain after massive ingestion of persimmons who developed signs of complicated small bowel obstruction. The patient had a previous history of Billroth II hemigastrectomy associated with truncal vagotomy to treat a chronic duodenal ulcer 14 years earlier. Since intestinal obstruction was suspected, he underwent emergency laparotomy that revealed an ileal obstruction with small bowel perforation and local peritonitis due to a phytobezoar that was impacted 15 cm above the ileocecal valve. After segmental intestinal resection, the patient had a good recovery and was discharged on the 6th postoperative day. This report provides evidence that diospyrobezoar should be considered as a possible cause of small bowel obstruction in patients who have previously undergone gastric surgery.

• Bezoars
• Diospyros kaki
• Intestinal obstruction
• Operative surgical procedure
• Persimmon

• Bezoars
• Bizarre
• Metal
• Nails and screws

A phytobezoar is one of the intraluminal causes of gastric outlet obstruction, especially in patients with previous gastric surgery and/or gastric motility disorders. Before the proton pump inhibitor era, vagotomy, pyloroplasty, gastrectomy and gastrojejunostomy were commonly performed procedures in peptic ulcer patients. One of the sequelae of gastrojejunostomy is phytobezoar formation. However, a bezoar causing gastric outlet obstruction is rare even with giant gastric bezoars. We report a rare case of gastric outlet obstruction due to a phytobezoar obstructing the efferent limb of the gastrojejunostomy site. This phytobezoar which consisted of a whole piece of okra (lady finger vegetable) was successfully removed by endoscopic snare. To the best of our knowledge, this is the first case of okra bezoar-related gastrojejunostomy efferent limb obstruction reported in the literature.

• Efferent limb obstruction
• Gastrojejunostomy
• Okra phytobezoar

AIM: To describe the clinical characteristics of patients with gastric or intestinal bezoars recently treated in our hospital.

METHODS: In this study, a retrospective chart review of consecutive patients with gastrointestinal bezoars, who were treated at the Samsun Education and Research Hospital between January 2006 and March 2011, was conducted. Data on demographic characteristics, clinical presentation, history of risk factors, diagnostic procedures, localization of bezoars, treatment interventions, and postoperative morbidity and mortality rates were collected and evaluated.

RESULTS: Forty-two patients [26 (61.9%) males and 16 (31.1%) females] with a mean ± SD (range) age of 55.8 ± 10.5 (37-74) years were enrolled in this study. Thirty-six patients (85.7%) had one or more predisposing risk factors for gastrointestinal bezoars. The most common predisposing risk factor was a history of previous gastric surgery which was identified in 18 patients (42.8%). Twenty three patients (54.8%) had multiple predisposing risk factors. Phytobezoars were identified in all patients except one who had a trichobezoar in the stomach. Non-operative endoscopic fragmentation was performed either initially or after unsuccessful medical treatment in 14 patients with gastric bezoars and was completely successful in 10 patients (71.5%). Surgery was the most frequent treatment method in our study, which was required in 28 patients (66.7%). Intestinal obstruction secondary to bezoars was the most common complication (n = 18, 42.8%) in our study.

CONCLUSION: The presence of multiple predisposing factors may create a synergistic effect in the development of bezoars.

• Bezoar
• Diospyrobezoars
• Persimmon
• Phytobezoar
• Trichobezoar

The authors report on 2 patients who had small bowel obstruction secondary to phytobezoars following Roux-en-Y gastric bypass.

Bowel obstruction is a known complication of Roux-en-Y gastric bypass. It can be caused by adhesions, internal hernia, incarcerated ventral hernia, or intussusception. Sometimes the underlying cause may be unusual. These 2 case reports describe patients who underwent laparoscopic Roux-en-Y gastric bypass and whose postoperative courses were complicated by small-bowel obstruction due to phytobezoars in the ileum, distal to the jejunojejunal anastomosis. We reviewed the literature by using PubMed and Medline for causes, pathogenesis, classifications, diagnosis, and management.

We investigated the significance and risk factors of bowel obstruction caused by the consumption of wild bananas (BOWB) in Laos. Of six patients with BOWB in Luang Namtha, North Laos, five required enterotomy for phytobezoars. All had eaten wild banana (WB) seeds.

Of 227 other patients/relatives: 91.2% had eaten WB; 46.3% had also eaten the seeds and 45.4% knew of complications resulting from eating WB; 42.3% were aware of the complications of ingesting the seeds (constipation [37.9%], appendicitis/abdominal pain/vomiting [2.6% each] and bloated stomach/death [1.3% each]). Middle/highland Lao ethnicity was associated with WB and seed consumption (odds ratio [OR] 9.91 and 2.33), male sex with WB consumption and unawareness (OR 4.31 and 1.78).

At all surgically-equipped hospitals in Laos, 33/44 doctors knew of BOWB, describing patients as young adults (16/30), male (24/30) and from middleland Lao (18/30). Countrywide, 46/48 patients with BOWB required laparotomy in 2009 (incidence 0.8/100,000). All consumed WB seeds. BOWB is widespread in Laos, especially among young middleland Lao men consuming WB seeds on an empty stomach.

Bezoars are uncommon findings in the gastrointestinal tract and are composed of a wide variety of materials. We report a case of a relapsing metal bezoar in a man with schizophrenia.

A 34-year-old man presented with a history of sub-acute onset of mild diffuse abdominal pain and abdominal distention. Physical examination revealed dullness to percussion in the upper and lower left quadrants. Past medical history was remarkable for epilepsy, schizophrenia and previous abdominal surgery for intestinal occlusion. Plain radiographs revealed objects of metal density contained within a dilated stomach. Celiotomy was performed revealing more than 350 metal objects inside the stomach. The patient was discharged and referred to a psychiatric facility.

Intestinal occlusion in patients with psychiatric disorders can result from rare causes such as bezoars. This report alerts surgeons to rule out bezoars in the differential diagnosis of intestinal occlusion in people with mental health problems.

• Acute Disease
• Critical Care
• Decision Making
• Humans
• Intestinal Obstruction/diagnosis
• Intestinal Obstruction/etiology
• Intestinal Obstruction/physiopathology
• Intestinal Obstruction/surgery
• Male
• Middle Aged
• Tomography, X-Ray Computed

• Adenocarcinoma/surgery
• Aged
• Anti-Ulcer Agents/adverse effects
• Anticholesteremic Agents/adverse effects
• Bezoars/chemically induced
• Bezoars/surgery
• Cholestasis/drug therapy
• Cholestasis/etiology
• Cholestyramine Resin/administration & dosage
• Cholestyramine Resin/adverse effects
• Colectomy
• Colon, Transverse/surgery
• Colonic Diseases/etiology
• Colonic Diseases/surgery
• Drug Therapy, Combination
• Female
• Gastrointestinal Agents/administration & dosage
• Gastrointestinal Agents/adverse effects
• Humans
• Intestinal Obstruction/etiology
• Intestinal Obstruction/surgery
• Octreotide/adverse effects
• Omeprazole/adverse effects
• Pancreatic Fistula/prevention & control
• Pancreatic Neoplasms/surgery
• Pancreaticoduodenectomy/adverse effects
• Proton Pump Inhibitors/adverse effects
• Risk Factors
• Treatment Outcome