Gastric and Rectal Phytobezoar From Sunflower Seed Ingestion: A Case Report and Review of the Literature.

Seed bezoars are a subcategory of phytobezoars caused by undigested vegetable seeds or fruit pits. We report the case of a 48-year-old woman who was admitted due to severe constipation and rectal pain. Rectal examination was notable for numerous sunflower seeds at the anal verge. Initial CT imaging revealed fecal impaction with a rectal bezoar which was managed with manual evacuation. Repeat CT imaging was notable for a gastric bezoar which was successfully managed by dissolution therapy with Coca-Cola. Most seed bezoars can be managed conservatively and life-threatening complications are rare.

Gastric bezoars secondary to mixed infection with Sarcina ventriculi and G + bacilli: a case report.

Sarcina ventriculi is a bacterium with a specific histological morphology and infection can present with symptoms such as abdominal pain, nausea, vomiting and occasionally fatal complications. Delayed gastric emptying is regarded as the most significant risk factor for infection. Its pathogenicity is currently unknown and treatment options are inconsistent. Here we report a case of gastric bezoars secondary to a mixed infection of Sarcina ventriculi and G + bacilli, which is diagnosed by a pathological biopsy.

Trans-umbilical Intragastric Surgery Using Two Alexis Wound Retractors for a Large Trichobezoar in a Four-Year-Old Girl: A Case Report.

Trichobezoars are difficult to remove endoscopically and often require surgery. We performed trans-umbilical intragastric surgery using two Alexis wound retractors with successful results in a pediatric patient with a trichobezoar. This method is a safe and cosmetically favorable option for the removal of large trichobezoars and does not require special techniques or instruments. It also contributes to the reduction of postoperative complications such as wound infection and intra-abdominal abscess.

Acute Case of Trichobezoar Diagnosed From Computed Tomography and 3D Images: Rapunzel Syndrome Re-examined.

A trichobezoar is a rare cause of abdominal pain due to an indigestible mass in the gastrointestinal tract that is composed of a patient's hair. If a trichobezoar grows and extends from the gastric body to the pylorus and into the small bowel, it is considered Rapunzel syndrome. We present a case of an 11-year-old female patient with Rapunzel syndrome who presented with four weeks of colicky abdominal pain, vomiting, constipation, and severe malnutrition. Computed tomography of the abdomen and pelvis with 3D rendering demonstrated a large bezoar, and the patient was successfully treated with exploratory laparotomy, gastrostomy, and removal of the trichobezoar intact.

Gastric Outlet Obstruction and Iron Deficiency Anemia Secondary to Gastric Bezoar: A Case Report.

Trichobezoars are an accumulation of undigested hair in the gastrointestinal system. They are a rare finding and are more likely in young females. Diagnosis is largely dependent on history taking and imaging, and treatment involves the removal and psychiatric evaluation.  We describe the case of a 21-year-old female with a history of gastroesophageal reflux disease (GERD) who presented with abdominal pain. Imaging showed a distended stomach with a suspected swallowed foreign substance. The patient subsequently underwent midline laparotomy, gastrotomy, and bezoar extraction. Postoperatively the patient was found to have trichotillomania, trichophagia, anxiety, depression, and symptomatic anemia. Initial management of gastric bezoars includes proper removal, but the additional follow-up needs to include psychiatric evaluation and treatment to prevent reoccurrence. It is also imperative to assess and treat underlying nutritional deficiencies.

Endoscopic Management of Unusual Bezoar in a Prader-Willi Syndrome Patient.

Bezoar occurs due to the ingestion of inedible material. The most common bezoar is a phytobezoar, which results from the ingestion of indigestible food particles found in vegetables and fruits. Other types include trichobezoar, which involves hair, lactobezoar, which involves milk products, pharmacobezoar, which involves medication, and in unusual cases, bezoar may involve different materials such as metals, plastics, and paper. We are presenting a case of a 19-year-old patient, a known case of Prader-Willi syndrome, who presented with difficulty breathing and tachypnea after aspiration of grape particles, and then he started to complain of melena and vomiting of dark content. He was admitted for urgent bronchoscopy and endoscopy, which showed a bezoar composed of grapes and threads. He was managed endoscopically by removing most of the threads and grape particles and releasing the tangled threads to facilitate its migration distally. Follow-up endoscopy showed complete resolution of the previously noticed content. We reported this case to discuss the endoscopic management of unusual bezoar involving threads.

Bezoar gástrico gigante. Presentación de un caso / Giant gastric bezoar. Presentation of case / Bezoar gástrico gigante. Apresentação de um caso

RESUMEN Se realizó un reporte de un caso de paciente femenina de 48 años de edad, con antecedentes patológicos personales de hipertensión arterial, cardiopatía isquémica, arritmias cardíacas y neurosis depresiva e ingestión diaria de cuerpos extraños desde hace algunos años, la cual tenía el hábito de masticar fragmentos de espuma de poliestireno (poliespuma), los que diluía en gasolina para poderlos moldear, ablandar e ingerirlos posteriormente. La paciente acudió a la consulta de Gastroenterología por presentar epigastralgia, acidez, sensación de repletes gástrica posprandial, aun cuando solo podía digerir escasas cantidades de alimento. Se realizó endoscopia, donde se apreció a la entrada de la luz gástrica un bezoar gigante de consistencia dura, superficie lisa, no movible, que midió aproximadamente 6-7 cm de diámetro, que ocupó prácticamente el 50 % de la luz gástrica, correspondiente al fundus y cuerpo gástrico, con extensión hacia el antro. Los intentos de extraerlo por vía endoscópica fueron fallidos, por lo que se intervino quirúrgicamente y se extrajo el mismo. La paciente tuvo una evolución posoperatoria favorable y egresó a los siete días, con seguimiento por consulta externa y tratamiento médico ambulatorio.

ABSTRACT A 48-year-old female presented to gastroenterologist consultation with epigastralgia, heartburn, and sensation of postprandial gastric fullness even when she only could intake meal in small proportion. She had a history of hypertension, ischemic heart disease, and cardiac arrhythmias, depressive neurosis associated to the ingestion, daily and since several years, of foreign bodies. She was used to chewing fragments of polyfoam, which she diluted them in gasoline in order to mold them, soften them and ingests them afterwards. An endoscopy procedure was used, which revealed, at the entrance of the gastric lumen, a giant bezoar of hard mass, smooth surface, non-movable, with approximately 6-7 cm size and occupying almost 50% of the gastric lumen region corresponding to the gastric body and fundus, and extending to the antrum. Attemps for removal the mass, endoscopically, were unsuccessful, so surgery was performed and it was removed successfully. The patient had a favorable postoperative evolution and was discharged 7 days after surgery, with outpatient follow-up and ambulatory medical treatment.

RESUMO Relatou-se o caso de uma paciente do sexo feminino, 48 anos, com história patológica pessoal de hipertensão arterial, cardiopatia isquêmica, arritmias cardíacas e neurose depressiva e ingestão diária de corpos estranhos há alguns anos, que tinha hábito de mastigar fragmentos de espuma de poliestireno (polyfoam), que ele diluiu em gasolina para poder moldar, amolecer e ingerir depois. A paciente compareceu à consulta de Gastroenterologia por apresentar epigastralgia, azia, sensação de plenitude gástrica pós-prandial, embora só conseguisse digerir pequenas quantidades de alimentos. Foi realizada endoscopia, onde um bezoar gigante de consistência dura, superfície lisa, imóvel, medindo aproximadamente 6-7 cm de diâmetro, ocupando praticamente 50% da luz gástrica, correspondente à luz gástrica, foi observado na entrada do lúmen gástrico, fundo e corpo gástrico, com extensão em direção ao antro. As tentativas de removê-lo endoscopicamente não tiveram sucesso, então ele foi submetido a uma cirurgia e foi removido. O paciente teve evolução pós-operatória favorável, com alta hospitalar sete dias após, com acompanhamento ambulatorial e acompanhamento médico ambulatorial.

Endoscopic treatment for a giant gastric bezoar: Sequential use of electrohydraulic lithotripsy, alligator forceps, and snares.

A 62-year-old woman with no past history was referred to our hospital for endoscopic treatment of a large gastric bezoar measuring 10 cm in diameter. The bezoar had a hard surface and huge volume. A tunnel was created at the center of the bezoar using electrohydraulic lithotripsy and was dilated using a through-the-scope balloon. The bezoar was then gradually crushed using alligator forceps and snares to decrease the risk of intestinal obstruction by the crushed bezoar fragments. The sequential use of electrohydraulic lithotripsy, alligator forceps, and snares according to the therapeutic plan enabled the endoscopic treatment of the giant gastric bezoar without surgery.

STOMACH BEZOARIS, CAUSES OF DEVELOPMENT, DIAGNOSIS AND METHODS OF TREATMENT.

OBJECTIVE: The aim: Is to determine the tactics and methods of treatment of bezoars of the gastrointestinal tract. PATIENTS AND METHODS: Materials and methods: From 2001 to 2019, 17 patients were diagnosed with "bezoar". RESULTS: Results: Due to the "weariness" of the clinic, the diagnosis was made in the first 3 days only for 3 (17,6 %) patients. On the basis of the obtained average pH values for 4 (23,5 %) patients established moderate hypoacid, for 4 (23,5 %) - pronounced hypoacid, for 6 (35,3 %) - anacid. For 5 (29,4 %) patients, the bezoars were withdrawn on the first attempt, while the other 5 (29,4 %) were "lumped". In the course of fibrogastroscopic examination, all patients were diagnosed with impaired motor-evacuation function of the stomach: gastroesophageal and duodenogastric refluxes, presence of passive discharge of the contents of the stomach into the esophagus. CONCLUSION: Conclusions: Therefore, the preconditions for the development of bezoars may be: hypo- and anacid, impaired motor-evacuation function of the stomach, chronic gastric ulcer,cognitive impairment. Endoscopic method should be preferred in the treatment, on condition of its failure - laparoscopic gastrotomy with bezoar extraction.

Trichobezoer: An Unusual Presentation with Congestive Heart Failure.

Description Trichobezoars are impactions of hair that accumulate in the gastrointestinal track and are most often located in the stomach. They are often associated with psychiatric illnesses like trichotillomania and trichophagia, which usually occurs in young and adolescent females. Gastric trichobezoars (GT) are the most common variety of bezoar found in the stomach. The most common complications that arise alongside GT include gastric erosion, ulceration or perforation of the small intestine. Gastric outlet obstruction, obstructive jaundice, pancreatitis and death have been reported, though these complications are rare. We report a 40-year-old female who presented to the hospital with dyspnea on exertion and ankle swellings. She also reported abdominal distension, a 40 pound weight loss, nausea and vomiting. Her examination was remarkable for sinus tachycardia, displaced apex beat and a split second sound. She was suspected of congestive heart failure. Upper endoscopy revealed a large trichobezoar in the antrum and the body of the stomach. She was found to be markedly anemic and in hypothyroid state. She underwent surgical removal of the GT subsequent to stabilization of heart failure. She later admitted to psychiatry a history of hair pulling and swallowing under stressful conditions.

Acute Presentation of Rapunzel Syndrome and a Review of Bezoars.

Bezoars have different compositions and can be subdivided into trichobezoar, phytobezoar, pharmacobezoar, lactobezoar and food bolus. The reported incidence of bezoar is 0.4% with phytobezoar being the commonest. Rapunzel syndrome is an extremely rare complication when trichobezoar crosses the pylorus to enter the duodenum, ileum and colon. We present the case of a 29-year-old female with a one-week history of abdominal pain, anorexia, nausea, vomiting, constipation, lethargy and a one-year history of increasing abdominal mass. Physical examination revealed a 20 cm palpable mass extending from the left upper quadrant to the umbilicus. Laboratory investigations demonstrated iron deficiency anemia and CT showed two well-defined foci within the gastric lumen consistent with trichobezoars. She was managed conservatively during her hospital stay and discharged home with a plan for elective laparotomy. We present this case to discuss the management of trichobezoars and to highlight the importance of early recognition of recurrence to avoid severe complications.

Gastric Bezoar: Cause of Weight Loss in a Patient With Previous Bariatric Surgery.

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.

Gastric bezoar.

Gastric bezoar is an accumulation of indigestible masses in stomach. Depending on the composites of these masses, descriptive names are given like tricobezoar if the mass contains hair. Most of the patients have psychological issues that result in their desire to eat hair which predispose them to have gastric tricobezoar. Unfortunately, the presentation is usually very late with signs of gastric outlet obstruction which include abdominal pain, distension, nausea and vomiting. There are typical findings seen in abdominal radiograph like large intraluminal filling defect with mottled translucency and ultrasound finding of shadowing intra-luminal masses. The treatment of such cases includes laproscopic trial to remove the bezoar and if not successful to proceed for gastrostomy.

Giant gastric bezoar removal from the stomach using combined dual knife-electric snare treatment: a case report.

Gastric bezoars are foreign bodies that occur when certain drugs or foods aggregate in the stomach. They cannot be digested and most are unable to pass through the pylorus. Here, we describe a giant hard gastric bezoar that was removed by using combined dual knife-electric snare treatment. This strategy has rarely been reported and can eliminate the need for surgery. The patient exhibited a giant hard gastric bezoar and reported a habit of eating persimmons. A giant persimmon bezoar was treated using a combined dual knife-electric snare approach, without any complications. Follow-up endoscopy revealed that the bezoar had been successfully removed. This report also provides a summary of the diagnostic and therapeutic courses of gastric bezoars.

Successful Emergency Endoscopic Treatment of Gastric Outlet Obstruction due to Gastric Bezoar with Gastric Pneumatosis.

Gastric bezoars are rare and are usually found incidentally. They can sometimes cause severe complications, including gastric outlet obstruction (GOO) or gastric pneumatosis (GP). In cases of bezoars with GP, the optimal treatment strategy has not yet been defined. We report the case of an 89-year-old man with a history of type 2 diabetes mellitus and hypertension who presented to our emergency room with a 2-day history of upper abdominal pain, nausea, and vomiting. Physical examination revealed no rebound tenderness or guarding, and laboratory values revealed no elevation of the serum lactate level. A computed tomography scan of the abdomen showed a dilated stomach with significant fluid collection, GOO, and GP due to a 42 × 40 mm mass composed of fat and air densities. Emergency esophagogastroduodenoscopy revealed two gastric bezoars, one of which was incarcerated in the pyloric region. We used various endoscopic devices to successfully break and remove the bezoars. We used endoscopic forceps and a water jet followed by an endoscopic snare to cut the bezoars into several pieces and remove them with an endoscopic net. Follow-up endoscopy confirmed that the gastric bezoar had been completely removed. As seen in this case, endoscopic treatment may be a safe and viable option for the extraction of gastric bezoars presenting with GOO and GP.

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

Nettle 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.

Gastric bezoar with small bowel obstruction.

In the operation performed on a patient with a history of abdominal surgery, a gastric bezoar and a small bowel bezoar were detected. Adhesive bowel obstruction was suspected; however, the patient was diagnosed with mechanical intestinal obstruction. Small bowel bezoar has resulted in intestinal obstruction. This case was discussed in accordance with the literature.

Endoscopic retrieval of a gastric trichobezoar.

A 9-year-old girl presented with a chief complaint of abdominal pain. Esophagogastroduodenal endoscopy (EGD) identified a long and large gastric trichobezoar extending into the duodenum. We attempted endoscopic retrieval after informed consent was obtained from the patient's mother. Initially, a gasper with 5-prolongs, commonly used for retrieval of endoscopically excised polyps, failed to remove the whole trichobezoar. When a net was used instead, it proved impossible to remove the trichobezoar completely. Therefore, we withdrew the scope from the mouth, leaving the net grasping the tricobezoar firmly in the stomach. Subsequently, we were able to retrieve about 70% of the trichobezoar manually by grasping the snare part of the net directly. A second pass found no deep laceration or perforation endoscopically. The remaining trichobezoar was completely retrieved with the net. The procedure was completed within 15 min. The retrieved specimens were 34 cm in length and 100 g in weight. The patient was discharged uneventfully 5 d thereafter. She was advised to visit a psychiatrist to avoid suffering from a relapse. Follow-up EGD showed no trichobezoar, and the patient's frontal hair grew back.