Although laparoscopic gastrolithotomy had been widely used in clinical practice, uncommon postoperative complications still require vigilance by medical staff.

Here we report a 67-year-old man who suffered for 18 months and underwent surgery several times due to a rare and undetected complication of laparoscopic gastricolithotomy. He presented to multiple hospitals because of sustained left upper quadrant abdominal pain one month after laparoscopic gastricolithotomy due to a large gastric bezoar caused by unrestrained eating of black dates and was diagnosed with possible intercostal neuritis. Many painkillers were used to relieve his symptoms but the condition progressed. Seven months after surgery, he was hospitalized as skin ulceration occurred in the left upper abdominal wall and was subsequently diagnosed with a massive thoracoabdominal wall abscess. One year after surgery, irreversible costal destruction was demonstrated. Both lesions were finally proved to be secondary damage due to a rare chronic gastro-abdominal wall fistula related to laparoscopic gastricolithotomy and the diameter of the gastric fistula reached 2 centimeters (cm). The patient was ultimately cured but underwent multi-regional incisions and drainage of the abscess, drainage of the gastric fistula, partial gastrectomy and removal of damaged ribs, and was followed-up for more than 4 years without recurrence. It is well-known that gastric fistula usually has an acute onset and occurs early after surgery, while chronic gastro-abdominal wall fistula especially with secondary massive thoracoabdominal wall abscess and costal destruction has rarely been reported.

This may be the first reported case of a chronic thoracoabdominal abscess and costal destruction caused by an undetected chronic gastro-abdominal wall fistula. We believe that this is a novel type of gastric fistula and the diagnosis and treatment were challenging.

• Gastro-abdominal wall fistula
• Thoracoabdominal wall abscess
• Costal destruction
• Laparoscopic gastricolithotomy
• Gastrolithiasis
• Case report

• anorexia
• diet
• endoscopy
• gastrolith
• stomach

• Emergency surgery
• Gastric perforation
• Gastric phytobezoar
• Laparoscopy
• Peritonitis

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

• Coca-Cola®
• endoscopic surgery
• gastric bezoars
• gastric outlet obstruction
• phytobezoars
• tannin

• Aged
• Bezoars/complications
• Bezoars/diagnostic imaging
• Bezoars/surgery
• Carbonated Beverages
• Coca
• Cola
• Gastric Outlet Obstruction
• Gastroscopy
• Humans
• Male
• Solubility
• Tannins

• Bezoars/diagnostic imaging
• Bezoars/etiology
• Bezoars/surgery
• Gastric Bypass/adverse effects
• Gastroplasty/adverse effects
• Humans
• Laparoscopy
• Obesity, Morbid/surgery
• Postoperative Complications/etiology
• Postoperative Complications/surgery
• Reoperation
• Retrospective Studies
• Treatment Outcome

•

Gastric outlet obstruction by a bezoar is a rare form of presentation.

Bezoars result from undigested material having an incidence of 0.4–1% (Gunner et al., 2012). Impaired gastrointestinal motility is one of the risk factors. The aim of this article is to highlight the importance of this commonly disregarded entity as well as the different treatment modalities available.

A 68-year-old female presented to our emergency department complaining of colicky lower left abdominal pain associated with vomiting and absence of bowel movements for the past 4 days. She had a previous history of a subtotal gastrectomy due to gastric cancer. The physical examination revealed a lower left quadrant palpable mass. Abdominopelvic CT scan showed distension of the gastric remnant with anastomotic obstruction caused by a bezoar. Attempted endoscopic dissolution of the bezoar was unsuccessful. The patient then underwent surgery enterotomy proximal to the obstruction with extraction of the mass.

Bezoars are responsible for 0.4%–4% of cases of mechanical gastrointestinal obstruction (Dikicier et al., 2015). Contrast-enhanced CT scan is the best diagnostic test with a sensitivity and specificity of 90% and 57%, respectively (Kim et al., 2003). Treatment options differ according to the type, size and location of the bezoar as well as clinical presentation. Conservative measures such as chemical dissolution and endoscopic fragmentation and extraction can be used with surgery being usually required for a bezoar-induced gastrointestinal obstruction.

The clinical findings of bezoar-induced ileus do not differ from the other different causes of mechanical intestinal obstruction. Hence, a high grade of suspicion and an early radiological exam are the keys for a prompt diagnosis and treatment.

• Bezoar
• Case report
• Gastric surgery
• Obstruction
• Small bowel
• Upper endoscopy

• Bezoar
• earth-eating
• eating disorder
• obsessive-compulsive disorder
• pica

Dried persimmon is a well-known dried fruit in Asian countries such as Japan, Korea, and China. Small bowel obstruction caused by phytobezoar is a rare but interesting pathogenesis that accounts for 2–4% of all small bowel obstructions. We present the case of an 87-year-old female who suffered from small bowel obstruction caused by ingestion of a huge, dried astringent persimmon. She was initially treated conservatively, but removal by enterotomy was performed after relief failed to be achieved with conservative therapy.

• Dried persimmon
• Phytobezoar
• Small bowel obstruction

A phytobezoar is a bezoar or trapped mass in the gastrointestinal system that consists of indigestible plant material such as fibers, skins and seeds. A persimmon phytobezoar (considered to be harder than other types of phytobezoars) is formed after frequent consumption of persimmons. The complication of gastrointestinal tract obstruction from bezoars was found to exist in the intestines but was rarely reported in the gastric tract because of its flexible volume. Here we present a 57-year-old man with persimmon phytobezoars, which ultimately led to gastric outlet obstruction.

• gastric outlet obstruction
• persimmon phytobezoar
• surgery

•

The patients that had a bariatric surgery are candidated to bezoar formation due to their potential eating disorders and because of the gastro-enterostomy.

We aimed to present a patient with gastric pouch bezoar after having a bariatric surgery.

Sixty-three years old morbid obese female had a laparoscopic Roux-en-Y gastric bypass surgery 14 months ago. She has lost 88% of her excess body mass index; but started to suffer from nausea, abdominal distention and vomiting lately, especially for the last two months. The initial evaluation by endoscopy, computed tomography (CT) and an upper gastrointestinal contrast series overlooked the pathology in the gastric pouch and did not display any abnormality. However, a second endoscopy revealed a 5 cm in diameter phytobezoar in the gastric pouch which was later endoscopically removed. After the bezoar removal, her complaints relieved completely.

The gastric bezoars may be confused with the other pathologies because of the dyspeptic complaints of these patients. The patients that had a bariatric surgery; are more prone to bezoar formation due to their potential eating disorders and because of the gastro-enterostomy made to a small gastric pouch after the Roux-en-Y gastric bypass surgery.

Possibility of a bezoar formation should be kept in mind in Roux-en-Y gastric bypass patients who has nausea and vomiting complaints. Removal of the bezoar provides a dramatic improvement in the complaints of these patients.

• Bariatric surgery
• Diabetes
• Interventional endoscopy
• Postoperative complications

• 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

• Bezoars
• Endoscopic removal
• Gastric ulcer
• Gastrointestinal endoscopy
• Ileus
• Persimmon phytobezoar
• Trichobezoar

• Aged
• Bezoars/pathology
• Diospyros/ultrastructure
• Humans
• Male
• Microscopy, Electron, Scanning
• Stomach

• Bezoars/therapy
• Carbonated Beverages
• Gastric Lavage/methods
• Gastrointestinal Motility/physiology
• Gastrointestinal Tract/drug effects
• Humans
• Stomach

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

Diospyros Lotus (“Wild Date Palm of Trabzon or Persimmon”), which has been proven to cause phytobezoars, is a widely consumed fruit in the Black Sea and Northeast Anatolia regions of Turkey. The aim of the present study was to investigate the effects of Diospyros Lotus together with other predisposing factors, on the development of gastrointestinal phytobezoars and to discuss the treatment results in comparison to the literature.

The records of 13 patients, who had been admitted to the General Surgery Clinic of Düzce Atatürk State Hospital between August 2008 and August 2011, were retrospectively reviewed. Demographic characteristics, predisposing factors, clinical and radiological findings, diagnostic and therapeutic methods, and the outcomes of the patients were recorded from the patient files. Written informed consent was obtained from each patient for publication of this research article and accompanying images.

All the patients had a history of consuming Diospyros Lotus. Of the patients, 30,7% had a history of previous gastric surgery, 30,7% had diabetes mellitus and 23% had dental implants. None of the patients had hypothyroidism, which is another predisposing factor for phytobezoars.

The phytobezoars were located in the stomach alone in 23% of the patients, whereas 15,3% was detected in the jejunum and stomach, 15,3% was detected in the jejunum alone, and 46,1% was detected in the ileum alone. All patients were treated with surgery, and there were no deaths.

Gastric phytobezoars are rare. Preventive measures have particular importance in the management of this condition, which is difficult to treat. For this purpose, excessive consumption of herbal nutrients containing a high amount of indigestible fibers such as Diospyros Lotus should be avoided in patients with a history of gastrointestinal surgery or poor oral and dental health.

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

A 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.

The 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.

The 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.

• Coca-Cola
• gastric phytobezoar
• upper gastrointestinal system endoscopy

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.

A bezoar is an intraluminal mass formed by the accumulation of undigested material in the gastrointestinal tract. A trichobezoar is a bezoar made up of hair and is a rare cause of bowel obstruction of the proximal gastrointestinal tract. They are seen mostly in young women with trichotillomania and trichotillophagia and symptoms include epigastric pain, nausea, loss of appetite and bowel or gastric outlet obstruction. We herein describe a case of a trichobezoar that presented as a gastric outlet obstruction and was subsequently successfully removed via a laparotomy.

• Obstruction
• Bezoar
• Trichobezoar
• Trichotillomania

AIM: To evaluate the efficacy of cola treatment for gastric phytobezoars, including diospyrobezoars.

METHODS: A total of 17 patients (range: 48 to 78 years) with symptomatic gastric phytobezoars treated with cola and adjuvant endoscopic therapy were reviewed. Three liters of cola lavage (10 cases) or drink (7 cases) were initially used, and then endoscopic fragmentation was done for the remnant bezoars by using a lithotripsy basket or a polypectomy snare. The overall success of dissolving a gastric phytobezoars with using three liters of cola and the clinical and endoscopic findings were compared retrospectively between four cases of complete dissolution by using only cola and 13 cases of partial dissolution with cola.

RESULTS: After 3 L of cola lavage or drinking, a complete dissolution of bezoars was achieved in four patients (23.5%), while 13 cases (76.5%) were only partially dissolved. Phytobezoars (4 of 6 cases) were observed more frequently than diospyrobezoars (0 of 11) in the group that underwent complete dissolution (P = 0.006). Gender, symptom duration, size of bezoar and method of cola administration were not significantly different between the two groups. Twelve of 13 patients with residual bezoars were completely treated with a combination of cola and endoscopic fragmentation.

CONCLUSION: The rate of complete dissolution with three liters of cola was 23.5%, but no case of diospyrobezoar was completely dissolved using this method. However, pretreatment with cola may be helpful and facilitate endoscopic fragmentation of gastric phytobezoars.

• Gastric phytobezoars
• Diospyrobezoars
• Cola
• Dissolution
• Clinical efficacy

AIM: To present our experiences in treating acute small intestinal obstruction due to bezoars (ASIOB) in adults without a history of gastric surgery.

METHODS: Fifteen adult ASIOB patients without a history of gastric surgery were treated in our hospital from April 2003 to April 2008. Abdominal X-ray and computed tomography (CT) scan were performed in all the patients, and conservative treatment was firstly used. Two old patients who could not endure operation were treated with foaming agent or cellulose. Laparotomy was performed in 11 of 15 cases as conservative treatment was not effective after 3 days. Another 2 cases were treated by laparoscopic operation.

RESULTS: Abdominal X-ray and CT scan showed air-fluid levels and presence of intraluminal hyperdense "stones", respectively. In 12 patients, bezoars were localized in the ileum, and in the rest 3 patients, they were found in the jejunum. The mean short-axis and long-axis diameters of the bezoars were 3.4 cm and 5.1 cm, respectively. Single bezoar was observed in 11 (73.3%) patients, and multiple bezoars were found in 4 (36.7%) cases. All of the 15 patients were cured without complications.

CONCLUSION: Bezoars-induced small bowel obstruction frequently occurs in distal jejunum and ileum in adults. Laparoscopic operation is safe and effective in treating this disease with advantages of shorter hospital stay and lighter pain.

• Bezoars
• Intestinal obstruction
• Laparoscope
• Diagnosis
• Treatment

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.

• Phytobezoar
• Disopyrobezoar
• Stomach

• 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

• coca-cola
• bezoar
• intestinal obstruction
• small intestine
• gastrointestinal endoscopy

• Acute Disease
• Aged
• Bezoars/complications
• Carbonated Beverages
• Cola
• Diospyros
• Endoscopy, Gastrointestinal
• Humans
• Intestinal Obstruction/diagnosis
• Intestinal Obstruction/etiology
• Intestine, Small/pathology
• Male
• Risk Factors

• Adult
• Aged
• Aged, 80 and over
• Bezoars/complications
• Bezoars/diagnosis
• Bezoars/surgery
• Chi-Square Distribution
• Diagnosis, Differential
• Diagnostic Imaging
• Female
• Humans
• Intestinal Obstruction/diagnosis
• Intestinal Obstruction/etiology
• Intestinal Obstruction/surgery
• Intestine, Small
• Male
• Middle Aged
• Risk Factors
• Treatment Outcome

• Bezoars/diagnosis
• Bezoars/etiology
• Bezoars/surgery
• Endoscopy
• Female
• Gastroparesis/complications
• Humans
• Lung Transplantation/adverse effects
• Male
• Middle Aged
• Pulmonary Disease, Chronic Obstructive/surgery
• Stomach

• Bezoars/diagnostic imaging
• Bezoars/surgery
• Gastroscopy
• Humans
• Laparoscopy
• Male
• Middle Aged
• Punctures
• Stomach/diagnostic imaging
• Stomach/surgery
• Tomography, X-Ray Computed

• Aged
• Bezoars/etiology
• Child
• Foreign Bodies
• Gastrointestinal Tract
• Humans

Plaster ingestion forming gastric bezoar is a strange way to attempt suicide and this method has not yet been reported. It may lead to a mechanical obstruction of the gut, especially the pyloric region, and could manifest with abdominal pain, epigastric distress, nausea, vomiting, and fullness.

Herein we report a case of a 37 year-old woman presenting with plaster ingestion and gastric outlet obstruction, who underwent surgery. At six months follow-up the patient was fully recovered.

Plaster has no toxic or erosive effects. Endoscopic or surgical removing of such material is recommended. Moreover, psychiatric intervention and management is imperative to prevent recurrence in such cases.

• Adult
• Bezoars/etiology
• Bezoars/surgery
• Calcium Sulfate
• Endoscopy
• Female
• Follow-Up Studies
• Gastric Outlet Obstruction/etiology
• Gastric Outlet Obstruction/surgery
• Humans
• Psychotherapy
• Stomach
• Suicide, Attempted/prevention & control
• Suicide, Attempted/psychology
• Time Factors

• Animals
• Chi-Square Distribution
• Decompression, Surgical/adverse effects
• Decompression, Surgical/methods
• Intestinal Obstruction/etiology
• Intestinal Obstruction/surgery
• Male
• Peritoneal Diseases/etiology
• Rats
• Rats, Wistar
• Tissue Adhesions/etiology