Iwamuro M, Yoshikawa T, Kamio T, Hirata S, Matsueda K, Kametaka D, Otsuka M. Temporal changes in computed tomography findings of a persimmon bezoar: A case report. World J Clin Cases 2025; 13(18): 103426 [DOI: 10.12998/wjcc.v13.i18.103426]
Corresponding Author of This Article
Masaya Iwamuro, MD, PhD, Assistant Professor, Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama 700-8558, Japan. pr145h2k@okayama-u.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Masaya Iwamuro, Tomoki Yoshikawa, Tomohiro Kamio, Shoichiro Hirata, Katsunori Matsueda, Daisuke Kametaka, Motoyuki Otsuka, Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
Author contributions: Iwamuro M wrote the manuscript; Yoshikawa T, Kamio T, Hirata S, Matsueda K, and Kametaka D contributed to the endoscopic diagnosis and treatment; Otsuka M revised the manuscript for important intellectual content; all the authors have read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient before writing this manuscript.
Conflict-of-interest statement: The authors declare no conflict of interest related to this manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This is an open-access article selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work noncommercially and license their derivative works on different terms, provided that the original work is properly cited and the use is noncommercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Masaya Iwamuro, MD, PhD, Assistant Professor, Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama 700-8558, Japan. pr145h2k@okayama-u.ac.jp
Received: November 26, 2024 Revised: January 18, 2025 Accepted: February 6, 2025 Published online: June 26, 2025 Processing time: 93 Days and 16.2 Hours
Abstract
BACKGROUND
Gastric bezoars are masses of indigestible material that accumulate in the stomach, causing nausea, abdominal pain, and vomiting. Persimmon bezoars (diospyrobezoars), which comprise tannins and fibers from persimmons, are relatively rare but may cause significant gastric complications, including gastric outlet obstruction or ileus. Although computed tomography (CT) is a useful imaging tool, diagnosing bezoars can be challenging because their density is similar to that of food debris and gastric content.
CASE SUMMARY
Here, we report the case of a 72-year-old woman with a persimmon bezoar that was diagnosed using serial CT imaging and confirmed by endoscopy. CT performed over several months revealed changes in the internal structure and density of the bezoar, suggesting progressive hardening. The patient had a history of a partial gastrectomy and excessive persimmon consumption, both of which are risk factors for bezoar formation. Endoscopic fragmentation of the bezoar successfully resolved symptoms.
CONCLUSION
Gastric bezoars, particularly persimmon bezoars, present diagnostic challenges because of their variable imaging characteristics. Serial CT can document temporal changes in bezoar density, potentially reflecting changes in hardness. Early diagnosis and endoscopic treatment are essential for effective management, particularly in patients with predisposing factors. This case underscores the importance of considering bezoars in the differential diagnosis of gastric masses, and highlights the value of CT for monitoring changes in bezoar characteristics over time.
Core Tip: Gastric bezoars, particularly persimmon bezoars, are rare but significant clinical entities that can lead to complications such as gastric outlet obstruction and ileus. Diagnosis can be challenging because they often appear similar to food debris on imaging. Serial computed tomography can be used to document temporal changes in the internal structure and density of bezoars, reflecting their progressive hardening over time. Early recognition and endoscopic fragmentation remain the most effective management strategies, particularly in patients with predisposing factors such as prior gastric surgery or excessive persimmon consumption.
