Whole-genome SNP genotyping unveils ancestral and recent introgression in wild and domestic goats.

After the domestication of goats around 10,000 years before the present (BP), humans transported goats far beyond the range of their wild ancestor, the bezoar goat. This brought domestic goats into contact with many wild goat species such as ibex and markhor, enabling introgression between domestic and wild goats. To investigate this, while shedding light on the taxonomic status of wild and domestic goats, we analysed genome-wide SNP data of 613 specimens from 14 taxonomic units, including Capra hircus, C. pyrenaica, C. ibex (from Switzerland, Austria, Germany and Slovenia), C. aegagrus aegagrus, C. a. cretica, C. h. dorcas, C. caucasica caucasica, C. c. severtzovi, C. c. cylindricornis, C. falconeri, C. sibirica sibirica, C. s. alaiana and C. nubiana, as well as Oreamnos americanus (mountain goat) as an outgroup. To trace gene flow between domestic and wild goats, we integrated genotype data of local goat breeds from the Alps as well as from countries such as Spain, Greece, Türkiye, Egypt, Sudan, Iran, Russia (Caucasus and Altai) and Pakistan. Our phylogenetic analyses displayed a clear separation between bezoar-type and ibex-type clades with wild goats from the Greek islands of Crete and Youra clustered within domestic goats, confirming their feral origin. Our analyses also revealed gene flow between the lineages of Caucasian tur and domestic goats that most likely occurred before or during early domestication. Within the clade of domestic goats, analyses inferred gene flow between African and Iberian goats. The detected events of introgression were consistent with previous reports and offered interesting insights into the historical relationships among domestic and wild goats.

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.

Endoscopic lithotripsy combined with drug lithotripsy vs. drug lithotripsy for the treatment of phytobezoars: analysis of 165 cases.

AIM: To analyze efficacy of endoscopic lithotripsy combined with drug lithotripsy as compared with drug lithotripsy for the treatment of phytobezoars. METHODS: We collected and evaluated case records of 165 patients with phytobezoars from 2014 to 2023. And we analyzed demographic and clinical characteristics, imaging features, endoscopic features, complications of phytobezoars, and compared efficacy between endoscopic lithotripsy combined with drug lithotripsy (Group A) and drug lithotripsy (sodium bicarbonate combined with proton pump inhibitor) (Group B). RESULTS: The median age of patients with phytobezoars was 67.84 ± 4.286 years old. Abdominal pain was the most common symptom and peptic ulcers (67.5%) were the most common complication. Bezoar-induced ulcers were more frequent in the gastric angle. The success rate of phytobezoars vanishing in Group A and Group B were similar (92.3% vs. 85.1% within 48 h, 98.7% vs. 97.7% within a week), while the average hospitalization period, average hospitalization cost, second endoscopy rate, and average endoscopic operation time were significantly lower in patients in Group B than in Group A. CONCLUSION: Drug lithotripsy is the preferred effective and safe treatment option for phytobezoars. We advise that an endoscopy should be completed after 48 h for drug lithotripsy.

Gastrointestinal trichobezoars in the pediatric population: a retrospective study.

BACKGROUND: Trichobezoar is an extremely rare condition characterized by a foreign body in the gastrointestinal tract (GIT) among children. The foreign body may exist in the digestive tract for several years, and it becomes evident if complications develop. The current study aimed to present 21 cases of GIT trichobezoars. METHODS: Retrospective analysis of children who were diagnosed with trichobezoars between August 2012 and December 2022. Patient demographics, clinical presentation, diagnosis, and therapy were collected and analyzed.Twenty-one patients had GIT trichobezoars. Data were collected and analyzed retrospectively. RESULTS: Twenty-one patients were identified. All patients were female. Their mean age at admission was 8.9 ± 1.9 years. Furthermore, 19 (90.5%) patients presented with abdominal pain, 16 (76.2%) with vomiting, and 13 (61.9%) with a palpable mass. Sixteen patients underwent gastroduodenoscopy. Among them, 15 had gastric trichobezoars. Moreover, 12 patients underwent computed tomography scan. Eight patients presented with gastric and small intestinal BZs, one presented with increased small intestinal contents with dilation, and one presented with abundant gastric contents. Then, 20 patients underwent surgery. Among them, five underwent laparoscopic-assisted minilaparotomy (LAML), and the rest underwent laparotomy. The results showed that 10 (50%) patients had gastric trichobezoars; 7 (35%), Rapunzel syndrome; and 3 (15%), small bowel trichobezoars. Two patients developed superficial wound infection postoperatively. One patient had a recurrent gastric trichobezoar. CONCLUSION: Trichobezoar should be considered in young girls with a history of hair eating or those with hair in the vomit or feces. Timely diagnosis and aggressive treatment are the keys to reducing complications and improving prognosis. Laparoscopic-assisted minilaparotomy is a safe, feasible, and effective surgical method for treating trichobezoars.

Rapunzel syndrome in children: a retrospective review of ten cases combined with literature review in a tertiary referral center.

PURPOSE: Rapunzel syndrome is an uncommon condition in children, and its clinical features remain unclear. This study presents the largest single-center series of pediatric cases to date, with the objective of documenting the clinical characteristics and treatment approaches for children with Rapunzel syndrome. METHODS: A retrospective study was conducted in children with Rapunzel syndrome from 2019 to 2023. We recorded age, gender, symptoms, locations of bezoar, complications, and treatment options. RESULTS: Ten patients with Rapunzel syndrome were included. The median age was 9.1 years, with all of whom were female. The most common clinical symptoms were upper abdominal mass (90%), abdominal pain (80%), and nausea and vomiting (50%). Complications occurred in six cases (60%), including small bowel obstruction (20%), severe gastric dilatation (10%), intestinal perforation (10%), choledochodilation (10%), acute pancreatitis with cholecystitis (10%). Preoperative ultrasonography suggested low-echoic foreign bodies continuing to the jejunum or ileocecal region in five cases (50%). Preoperative gastroscopy attempted in four cases (40%) to remove the foreign bodies, all of which failed. All patients underwent surgical treatment, with nine cases undergoing gastric incision foreign body removal, and one case undergoing gastric incision foreign body removal combined with intestinal perforation repair. All patients recovered well. No recurrence was observed during follow-up. CONCLUSION: The accuracy of ultrasound diagnosis in identifying Rapunzel syndrome is high; however, it may lead to misdiagnosis if not complemented with the patient's medical history. Endoscopic presents a heightened treatment risk and a reduced success rate. The condition commonly presents with severe complications, thus making laparotomy a safe and effective option for intervention.

Computed tomographic diagnosis and clinical outcomes of small intestinal obstruction caused by trichobezoars in client-owned rabbits.

Small intestinal obstruction in rabbits, although demonstrated to be common, is still poorly characterized. The objective of this study was to report features of small intestinal obstruction caused by trichobezoars in rabbits upon CT and their clinical outcomes. Rabbits with a diagnosis of intestinal obstruction that underwent CT scanning were included in this study. From each CT scan, obstruction location, appearance, Hounsfield units, size (mm), volume (mm3), distance from the stomach, and diameter of the small intestine proximal and distal to it, were extracted. Nine rabbits were included in the study. All rabbits presented for anorexia and had a distended or enlarged stomach (7) or abdomen (2). CT scan showed a non-contrast-enhancing, ovoid, smoothly marginated structure with a hyperattenuating rim, heterogeneous center, and variable amount of centrally located gas, in the duodenum (5), the jejunum (2), or the ileum (2). The density of the trichobezoars ranged from -156 to 58 HU (median, -44 HU) and volume ranged from 86.1 to 633.8 mm3 (median, 320.6 mm3). Three rabbits underwent medical management. Two of them survived, and one of them died. Six rabbits underwent surgery, of which three were successfully discharged from the hospital. CT proved to be a valuable imaging modality in rabbits with a suspected intestinal obstruction to provide the exact location of the obstruction and the characteristics of the obstructive material. The location and size of the trichobezoar may have relevant clinical implications.

Unveiling a Silent Obstructor: Phytobezoar in the Third Duodenal Segment.

We present a case of obstruction in the third portion of the duodenum secondary to a phytobezoar in an adult patient with no surgical history and without a vegan diet. High intestinal obstruction due to a phytobezoar is rarely described in the literature, posing a diagnostic challenge when evaluating potential differentials in the emergency setting. Subsequently, we conduct a review focusing on tomographic findings and the surgical specimen, highlighting key points to consider when addressing such pathologies.

Expect the unexpected: bezoar-caused gastric perforation in the 19-year-old patient, after traffic accident.

A 19-year-old female involved in a traffic accident presented to the Emergency Room (ER) with no trauma-related symptoms but a palpable mass in the epigastrium. Imaging revealed a massive trichobezoar causing gastric perforation. Urgent laparotomy was performed, and a 1.5-kilogram bezoar was removed, along with repairing coexisting gastric ulcers. The patient had a history of trichophagia, suggesting a psychiatric association. This case highlights the potential of trichobezoars to cause gastric perforation, even in patients admitted for unrelated reasons. CT-scan proves effective in diagnosing such cases. While a traffic accident might be a plausible cause, the presence of a bezoar can elevate the risk of complications. Psychiatric evaluation is recommended when trichophagia is identified. The study underscores the need for vigilance in unexpected scenarios, demonstrating the importance of multidisciplinary approaches in managing such cases.

Point-of-Care Ultrasound of a Pediatric Gastric Trichobezoar: A Case Report.

ABSTRACT: This case report describes a previously healthy pediatric patient with acute onset of abdominal pain and distention who was found to have an epigastric mass on physical examination. Point-of-care ultrasound (POCUS) demonstrated a large gastric mass with ultrasonographic features consistent with a trichobezoar. After POCUS was performed, trichophagia was confirmed on history, and the patient went to the operating room for removal of a large trichobezoar. We conclude POCUS may be helpful for evaluation of epigastric masses and diagnosis of gastric trichobezoars. We review the ultrasound technique, sonographic findings, and literature regarding ultrasound diagnosis of trichobezoars.

Duodenal diastatic perforation due to double gastric and jejunal trichobezoar in a patient with Rapunzel syndrome.

Rapunzel syndrome is a rare clinical entity in which a trichobezoar is produced by the ingestion of hair at the gastric level, extending in the form of a tail towards the duodenum. It occurs in young patients with trichotillomania and trichophagia. We present the case of a 24-year-old woman with a history of anxiety without treatment, who for 10 years presented trichotillomania and trichophagia, producing a picture of intestinal obstruction that required surgical intervention, evidencing a giant Trichobezoar throughout the gastric cavity and one jejunum associated with diastatic perforation. duodenal.

Endoscopic administration of Coca-Cola for medical management of a wedged intestinal trichobezoar in a cat.

A 16-year-old, neutered male domestic longhair feline with gastroduodenal and jejunal trichobezoars was treated with administration of Coca-Cola through endoscopic injection catheter. Examination with a Karl Storz endoscope identified a trichobezoar causing suspected partial or early complete obstruction of the jejunum; however, the length of the scope was inadequate to retrieve the trichobezoar. Consequently, 55 mL of Coca-Cola and 5 mL of iohexol were instilled into an injection catheter to disrupt the trichobezoar. No peri- or postoperative complications were reported, and the cat recovered uneventfully. Key clinical message: This case report demonstrates a minimally invasive approach to treatment of a small intestinal trichobezoar in a cat with no intra- or postoperative complications. Coca-Cola infusion through an endoscopic injection catheter may be a viable treatment in cats when a surgical approach is not an option, although further cases are needed to determine whether these results can be generalized to the larger patient population.

Administration endoscopique de Coca-Cola pour la prise en charge médicale d'un trichobézoard intestinal coincé chez un chat. Un félin domestique à poil long mâle castré de 16 ans atteint de trichobézoards gastroduodénaux et jéjunaux a été traité par l'administration de Coca-Cola via un cathéter d'injection endoscopique. L'examen avec un endoscope Karl Storz a identifié un trichobézoard suspecté d'obstruction partielle ou complète précoce du jéjunum; cependant, la longueur de l'endoscope était insuffisante pour récupérer le trichobézoard. Par conséquent, 55 ml de Coca-Cola et 5 ml d'iohexol ont été instillés dans un cathéter d'injection pour défaire le trichobézoard. Aucune complication péri- ou postopératoire n'a été signalée et le chat s'est rétabli sans incident.Message clinique clé :Ce rapport de cas démontre une approche peu invasive du traitement d'un trichobézoard de l'intestin grêle chez un chat sans complications per- ou postopératoires. L'infusion de Coca-Cola via un cathéter d'injection endoscopique peut être un traitement viable chez les chats lorsqu'une approche chirurgicale n'est pas une option, bien que d'autres cas soient nécessaires pour déterminer si ces résultats peuvent être généralisés à une population de patients plus large.(Traduit par Dr Serge Messier).

An atypical death from Rapunzel syndrome: a case report.

Trichotillomania is a psychiatric disorder characterized by recurring urges to pulling out hairs, eyelashes, or down in other parts of the body. Trichophagia, which is the urge to ingesting the pulled-out hairs, can cause Rapunzel syndrome, an unusual disorder where gastric trichobezoars can be found in the small intestine. Trichobezoars, amorphous masses composed of undigested food formed by hairs, can obstruct the gastrointestinal tract up to simulating symptoms typical of bowel obstruction. Rapunzel syndrome, named after Grimm's tale, may cause death, especially in the pediatric population, being it seldom over the age of 6; moreover, developing countries and environmental and familiar issues are listed as uncertain risk factors. The present case report deals with the death of a 4-year-old female occurred after lunch and following a series of vomit events; while no traumatic or pathological findings were revealed at the external examination, the autopsy revealed three large trichobezoars localized in the stomach and the small intestine. Despite death was due to gastrointestinal obstruction for multiple trichobezoars and collateral bronchoaspiration of dietary material, histological findings were totally non-specific, meaning that it is sometimes difficult to conclude that death is related to the primary pathological condition.

Phytobezoar-Induced Mechanical Ileus and Incipient Intussusception: A Case Report.

Phytobezoars constitute conglomerates of indigested plant fibers and are a rare cause of acute mechanical ileus. They exhibit an increased prevalence in the elderly population and people with specific predisposing conditions. Radiological imaging can often set a definitive diagnosis and dictate the optimal therapeutic approach, combined with the patient's clinical status. An 81-year-old male presented with deteriorating clinical symptoms of intestinal obstruction, and an exploratory laparotomy was performed following inconclusive radiological findings; multiple phytobezoars and incipient intussusception were revealed intraoperatively. A patient's medical history can often raise clinical suspicion of phytobezoars. However, a careful etiological investigation is imperative in all cases of mechanical ileus in advanced ages; early detection and dissolution of phytobezoars, when applicable, can reduce the need for surgical interventions.

Novel endoscopic tangential sawing technique in treatment of giant gastric bezoars: a retrospective single-center study (with video).

BACKGROUND AND AIMS: The current methods for treatment of giant gastric bezoars mainly include chemical dissolution, endoscopic fragmentation, and surgical removal, which often have limited curative effects or generate multiple adverse events. Therefore, there is an urgent need to find new methods to overcome such a dilemma. The aim of this study was to evaluate the safety, efficacy, and feasibility of a novel guidewire-based tangential sawing fragmentation (GTSF) technique to treat giant gastric bezoars. METHODS: This retrospective single-center study was performed in the Department of Gastroenterology and Hepatology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital. Ten patients with giant bezoars were consecutively enrolled from December 8, 2019 to April 8, 2021. We treated the 10 patients with the GTSF technique, recorded the GTSF procedure, and followed the patients with gastroscopy 2 weeks after the procedure. RESULTS: All patients were successfully treated by the GTSF technique, and the giant bezoar was broken into small pieces (<2 cm in diameter). The average operation time was 21.73 minutes, and the average fragmentation time was 8.06 minutes. Ten patients treated with the GTSF technique attained satisfactory treatment results, with no acute adverse events or alimentary canal injury during the procedure, and no bezoar residue remained as shown by gastroscopy 2 weeks after the procedure. CONCLUSIONS: The GTSF technique is a safe, effective, and feasible method for removing giant bezoars and can be considered as an alternative treatment of this disease.

Uncommon cause of respiratory failure due to a bezoar in the hypopharynx: a case report.

BACKGROUND: Trichotillomania and trichophagia cause trichobezoars, which are masses made of hair. The main presentation of this condition is abdominal pain. However, other complications include gastric outlet obstruction, nausea, vomiting, weight loss, malnutrition, hematemesis, diarrhea, and constipation. CASE PRESENTATION: A 57-year-old woman with trichotillomania was admitted to the Emergency Department with the chief complaints of dyspnea on exertion, shortness of breath, dysphagia, generalized weakness, and hoarseness. Spiral chest computed tomography (CT) scan did not reveal any parenchymal lesions Pulmonary CT angiography did not reveal pulmonary embolism. The patient was admitted to the Surgery Department for hand fasciotomy due to contrast leakage, and during laryngoscopy, a trichobezoar was detected that was removed with Magill forceps. CONCLUSIONS: Rare cases of trichobezoars can be observed in humans with gastrointestinal and respiratory symptoms. Precise and timely diagnosis are key for the prevention of more invasive diagnostic procedures.

Treatment of Children Trichobezoar a Retrospective Study of 11 Cases.

PURPOSE: The goal of this study to summarize the clinical features, treatment and prognosis of children trichobezoar, and to guide the clinical diagnosis and treatment. METHODS: The clinical manifestations, auxiliary examination results, diagnosis and treatment process and family relationship of 11 cases of children with trichobezoar in our hospital were analyzed retrospectively. RESULTS: 11 cases were female, 4 cases were divorced single parent family, and 2 case was left behind child. Six patients were admitted to hospital with sudden exacerbation of chronic abdominal pain, and four of them had recurrent vomiting. Five patients were admitted to hospital with acute abdominal pain, and 3 of them had vomiting symptoms; The weight of 1 case was lower than -2 SD, 4 cases were between -2 SD ~ -1 SD. 6 cases had palpable left upper abdominal mass with mild tenderness, 1 case only had left upper abdominal tenderness, 4 cases had no positive abdominal signs; The results of color Doppler ultrasonography in 8 children indicated the strong echo mass in the stomach, and 3 of them showed that the hyperechoic group extended to duodenum through pylorus. 7 cases had a tail end extending into the small intestine after removing the gastrolith during the operation. Four cases were found with jejunal perforation, 2 cases were treated with intestinal resection and anastomosis, and 2 cases were treated with intestinal repair. All the children were improved and discharged after operation. CONCLUSION: For single parent families or left behind children with a history of chronic abdominal pain, vomiting and trichophilia, gastric hair stones should be highly suspected. For large hair stones in the stomach, they should be removed surgically. During the operation, the small intestine should be explored routinely to prevent the missed diagnosis of small intestinal perforation. Psychological guidance should be given to the children and their parents to prevent recurrence.

Sex Differences in Age at Onset and Presentation of Trichotillomania and Trichobezoar: A 120-Year Systematic Review of Cases.

Trichotillomania (hair-pulling disorder) has high female preponderance. It has been suggested that onset in early childhood represents a distinct developmental subtype that is characterized by higher prevalence of males compared to later onset cases. However, the empirical literature is scarce. We conducted a systematic review of case reports to examine the distribution of age at onset/presentation in males and females with trichotillomania or trichobezoar (a mass of hair in the gastrointestinal tract resulting from ingesting hair). We identified 1065 individuals with trichotillomania and 1248 with trichobezoar. In both samples, males, compared to females, had earlier age at presentation and greater proportion of cases in early childhood. These sex differences remained after potential confounding variables were accounted for. The results showed similar sex differences for age at onset, which was reported in 734 and 337 of the trichotillomania and trichobezoar cases, respectively. The findings may reflect neurodevelopmental underpinnings in early childhood trichotillomania.

Therapeutic approach of esophageal bezoar due to enteral feed.

Enteral feed bezoars are a rare and difficult to treat complication of enteral feeding. In our case, we report the case of a young man with prolonged admission at the intensive care unit; who requires enteral nutrition. This doesn't run properly after a week; which is why we performed an endoscopy with the finding of an esophageal bezoar that didn't respond to endoscopic treatment at first; being finallay resolved with a second endoscopic therapy after treatment with solvent substances.

Esophageal pharmacobezoar: a very unusual complication of enteral nutrition use.

Enteral nutrition in intensive care has been a great advance in medicine, due to its benefit, cost-effectiveness and few complications. Bronchoaspiration, diarrhea, regurgitation or mechanical problems are the main adverse effects. Esophageal obstruction by bezoar is a very infrequent complication, and there are only a few cases described in the literature.

Multiple bezoars causing small bowel obstruction: a unique case of resolution with upper and low GI endoscopy.

Reports of obstructing foreign bodies in the small bowel are rare and the majority describe surgical resolution. We report a case of successful endoscopic treatment of a small bowel obstruction (SBO) caused by multiple bezoars. A 92-year-old female presented to the Emergency Department with a history of persistent vomiting. Computed tomography (CT) showed gastric distension and an intraluminal ovaloid foreign body with a heterogenous density in the second portion of the duodenum, suggestive of bezoar.