Obstrução gástrica por bezoar / Gastric obstruction due to bezoar

A obstrução por bezoar é um acúmulo de material parcialmente ou não digerido no estômago. Bezoares gástricos são raros e ocorrem com mais frequência em pacientes com transtornos de comportamento, esvaziamento gástrico anormal ou após cirurgia gástrica. Podem ser assintomáticos ou apresentar sintomas como dor abdominal e vômitos incoercíveis. Podem ainda ter composições diversas e ocorrer em todas as faixas etárias. O objetivo deste relato foi demonstrar um caso de bezoar gástrico em paciente previamente submetido à cirurgia bariátrica e internado com quadro de vômitos incoercíveis e hemorragia digestiva alta, com a demonstração de que sua resolução completa ocorreu na realização da segunda endoscopia.

Bezoar obstruction is an accumulation of partially digested or undigested material in the stomach. Gastric bezoars are rare and occur more frequently in patients with behavioral disorders, abnormal gastric emptying, or after gastric surgery. They may be asymptomatic or present with symptoms such as abdominal pain and incoercible vomiting. They can have diverse compositions and occur in all age groups. The aim of this report was to demonstrate a case of gastric bezoar in a patient who previously underwent a bariatric surgery and was hospitalized with incoercible vomiting and upper gastrointestinal hemorrhage, with the demonstration that its complete resolution occurred during the second endoscopy.

Cecum perforation associated with a calcium polystyrene sulfonate bezoar - a rare entity / Perfuração do ceco associada a bezoar de poliestirenossulfonato de cálcio - uma entidade rara

Abstract Hyperkalemia is one of the most common electrolyte disorders, responsible for a high number of adverse outcomes, including life-threatening arrhythmias. Potassium binders are largely prescribed drugs used for hyperkalemia treatment but unfortunately, there are many adverse events associated with its use, mostly gastrointestinal. Identification of patients at highest risk for the serious complications associated with the current potassium binders, such as colon necrosis and perforation, could prevent fatal outcomes. The authors present a case of a 56-year-old man with secondary diabetes and chronic renal disease that was treated for hyperkalemia with Calcium Polystyrene Sulfonate (CPS). He later presented with acute abdomen due to cecum perforation and underwent ileocecal resection but ultimately died from septic shock a week later. During surgery, a solid white mass was isolated in the lumen of the colon. The mass was identified as a CPS bezoar, a rare drug-mass formed in the gastrointestinal tract that contributed to the perforation. A previous history of partial gastrectomy and vagothomy was identified as a probable risk factor for the CPS bezoar development. Hopefully, the two new potassium binders patiromer and (ZS-9) Sodium Zirconium Cyclosilicate will help treat such high-risk patients, in the near future.

Resumo A hipercalemia é um dos distúrbios eletrolíticos mais comuns, responsável por um grande número de desfechos adversos, incluindo arritmias potencialmente fatais. Quelantes de potássio são amplamente prescritos para o tratamento da hipercalemia, mas infelizmente são muitos os eventos adversos associados ao seu uso, em particular os gastrointestinais. A identificação de pacientes com risco mais elevado para complicações graves associadas aos quelantes de potássio atualmente em uso, como necrose e perfuração do cólon, pode evitar desfechos fatais. O presente artigo descreve o caso de um homem de 56 anos com diabetes secundário e doença renal crônica em tratamento por hipercalemia com poliestirenossulfonato de cálcio (PSC). Posteriormente o paciente apresentou abdômen agudo devido a perfuração do ceco e foi submetido a uma ressecção ileocecal, mas acabou indo a óbito por choque séptico uma semana mais tarde. Durante a cirurgia, uma massa branca sólida foi isolada no lúmen do cólon. A massa foi identificada como um bezoar de PSC, uma massa de fármaco de rara ocorrência formada no trato gastrointestinal que contribuiu para a perfuração. História pregressa de gastrectomia parcial e vagotomia foi identificada como provável fator de risco para o desenvolvimento do bezoar de PSC. Espera-se que os dois novos quelantes de potássio - patiromer e ciclossilicato de zircônio sódico - ajudem a tratar pacientes de alto risco em um futuro próximo.

Obstrucción intestinal por fitobezoar en una paciente con bypass gástrico laparoscópico en Y de Roux: reporte de un caso / Intestinal obstruction due to phytobezoar in a patient with laparoscopic gastric bypass in Roux-en-Y: case report

INTRODUCCIÓN: Los bezoares son una etiología infrecuente de obstrucción intestinal (OI) posterior a un bypass gástrico laparoscópico en Y de Roux (BGLYR). OBJETIVO: Describir un caso clínico de OI debido a un fitobezoar en un sitio infrecuente, en una paciente 2 años después de un BGLYR. CASO CLÍNICO: Paciente de sexo femenino con antecedente de BGLYR hace 2 años y cuadro de obstrucción intestinal causado por fitobezoar. DISCUSIÓN: Se discuten los factores que pueden contribuir a la formación del bezoar en este caso y estrategias para su prevención. Se destaca la importancia del estudio imagenológico y de la exploración quirúrgica oportuna.

BACKGROUND: Bezoars are an infrequent aetiology of bowel obstruction after a laparoscopic Roux-en-Y gastric bypass (LRYGB). OBJECTIVE: To describe a clinical case of bowel obstruction due to a phytobezoar in an uncommon site, in a patient 2 years after a LRYGB. CASE REPORT: A female patient with a history of LRYGB 2 years ago and bowel obstruction due to phytobezoar. DISCUSSION: Factors that can contribute to the formation of bezoar in this case and strategies for its prevention are discussed. The importance of the imaging study and timely surgical exploration is emphasized.

Síndrome de Rapunzel gigante con complicación atípica: Reporte de un caso / Giant Rapunzel syndrome with atypical complication: Report of a case

El síndrome de Rapunzel es una forma inusual y rara de tricobezoar gástrico que se extiende al intestino delgado. La formación es debida a la ingestión continua de cabello la cual lleva a la impactación del mismo junto con moco y alimento, pero es infrecuente que se produzca perforación gástrica. Reportamos el caso de una paciente de sexo femenino de 16 años de edad admitida en nuestra institución con antecedentes de depresión y cuadro clínico caracterizado por náuseas, epigastralgia severa y pérdida patológica de peso. Al examen físico se evidenció un abdomen tenso con reacción peritoneal, la tomografía de abdomen contrastada evidenció un estomago distendido con contenido heterogéneo que se extiende hacia el duodeno, hidroneumoperitoneo y líquido en fondo de saco de Douglas, por lo que se le decidió realizar una laparotomía exploratoria que evidenció perforación en cara anterior de estómago que es una complicación infrecuente, por lo que se procedió a la extracción del tricobezoar gigante con extensión duodenal; evolucionando de forma favorable remitiéndose la paciente a controles ambulatorios con psiquiatría; finalmente se le realizó una endoscopía alta a los 6 meses que evidenció la cicatriz del procedimiento quirúrgico.

Rapunzel syndrome is an unusual and rare form of gastric trichobezoar that extends into the small intestine. The formation is due to the continuous ingestion of hair which leads to the impaction of the hair along with mucus and food, but it is rare that gastric perforation occurs. We report the case of a female patient of 16 years of age admitted to our institution with a history of depression and clinical symptoms characterized by nausea, severe epigastralgia and pathological loss of weight. The physical examination showed a tense abdomen with a peritoneal reaction. Contrast-enhanced tomography showed a distended stomach with a heterogeneous content that extended to the duodenum, hydro pneumoperitoneum, Douglas sack bottom liquid, and it was decided to perform an exploratory laparotomy. Showed perforation in the anterior face of the stomach which is infrequent, so we proceeded to the extraction of giant trichobezoar with duodenal extension; Evolving favorably, the patient being referred to outpatient controls with psychiatry; Finally, a high endoscopy was performed at 6 months, which evidenced the scar of the surgical procedure.

Síndrome de Rapunzel en una adolescente: causa de suboclusión intestinal / Rapunzel syndrome in teenager: Intestinal subocclusion cause

Resumen Objetivo: Presentar un caso de síndrome de Rapunzel. Esta es una enfermedad poco frecuente que consiste en una variante de tricobezoar gástrico que se extiende hasta la segunda porción del duodeno. Caso clínico: Paciente femenina adolescente con antecedentes de atresia tricuspídea tratada quirúrgicamente. Presentó dolor abdominal de 3 días de evolución en el hipocondrio izquierdo irradiado al hipocondrio derecho, con distensión abdominal, náuseas y vómitos. Al examen físico presentó un perímetro abdominal de 58 cm y ruidos hidroaéreos disminuidos. La laparotomía exploratoria con gastrostomía anterior mostró una masa de cabellos entrelazados de aproximadamente 40 cm de longitud, compatible con tricobezoar, que se extendió desde el fondo gástrico hasta la segunda porción, llamado síndrome de Rapunzel, provocando suboclusión intestinal. Conclusión: El diagnóstico temprano permite evitar complicaciones, que pueden ser graves. Se recomienda un manejo multidisciplinario con el servicio de psiquiatría para controlar la enfermedad de base.

Abstract Aim: Present a case of Rapunzel syndrome, this is a rare disease that is a variant of gastric tricobezoar which extends to the second portion of duodenum. Case report: Female patient with tricuspid atresia treated surgically. Abdominal pain three days of evolution on the left upper quadrant radiating to the right upper quadrant with abdominal distension, nausea and vomiting. Abdominal circumference was 58 cm, decreased bowel sounds. The exploratory laparotomy presenced of a mass formed by interlocking hair, approximately 40 cm long with a compatible tricobezoar that spread from the gastric fundus to the duodenum called Rapunzel síndrome and caused partial bowel obstruction. Conclusion: Early diagnosis can prevent complications, which can be severe, a multidisciplinary management is recommended in psychiatry service to control the underlying disease.

Tricobezoar / Trichobezoar

Cuando los cuerpos extraños permanecen en el tubo digestivo del hombre por largo tiempo y resisten la acción de los jugos digestivos, forman concreciones a las que se les denomina bezoares. Los bezoares pueden estar compuestos por uno o varios tipos de materia, como los pelos de las personas (tricobezoares). En este trabajo se analiza el caso de una paciente femenina, de 24 años de edad, procedencia rural, que acude a servicio de urgencias por la presencia de dolor abdominal difuso, fundamentalmente en epigastrio, y que se irradia a todo el abdomen; además presenta vómitos y diarreas que contienen pelos. La endoscopia digestiva alta evidenció un cuerpo extraño que ocupaba toda la luz gástrica. Se realizó laparotomía exploradora y gastrotomía longitudinal anterior, en la que se encontró una gran masa compacta de aspecto oscuro. El informe anatomopatológico de la pieza, describió una muestra con forma de masa alargada, compuesta por pelo procedente del cuero cabelludo

When foreign bodies remain in the human digestive tract for a long time and tolerate the digestive juices, the produce concretions called benzoars, which may be composed by one of several types of matter, by example the hairs (trichobezoars). The objective of present paper is to analyze the case of a female patient aged 24 arriving from rural zones, who came to emergency services due to a diffuse abdominal pain, mainly in epigastrium irradiating to all the abdomen; also, had vomiting and diarrheas containing hairs. The high digestive endoscopy demonstrated a foreign body occupying all the gastric lumen. An exploratory laparotomy and anterior longitudinal gastrotomy were carried out noting a large compact mass of obscure appearance. The sample anatomical-pathological report described an enlarged mass consisting of hair from the scalp

Síndrome de Rapunzel: revisão de literatura / Rapunzel syndrome: a literature review

Tricobezoar gastroduodenal é definido como o acúmulo de cabelos e pelos no trato gastrointestinal, tendo como origem a ingestão dessas substâncias. As autoras relatam o caso de um volumoso tricobezoar associado à síndrome de Rapunzel, em jovem do sexo feminino com história de tricotilofagia e emagrecimento. Foram utilizados, como base de dados, a revisão de prontuário, a avaliação dos exames realizados e o acompanhamento durante o ato operatório. Apesar de ser um caso incomum, é necessário aventar sua hipótese diagnóstica diante de uma clínica exuberante como a da referida paciente. Não somente o bezoar deve ser adequadamente tratado, mas também a causa subjacente que levou a paciente à ingestão de cabelos.

Gastroduodenal trichobezoar is the accumulation of hair inside the gastroduodenal tract, originated by the ingestion of such object. On the presented study is reported the case of a voluminous trichobezoar associated with Rapunzel's syndrome on a young female with history of trichophagia and weight loss. With this purpose, chart review, assessment of the tests, and monitoring during the surgery were used. Despite being an unusual case, it should be suspected in a clinical exuberant as the patient, and must be properly treated, not only the bezoar itself, but the underlying cause that led to the ingestion of hair.

Small intestinal obstruction caused by a phytobezoar: a case report

Phytobezoar is a concretion formed in the stomach or intestine and composed chiefly of undigested compacted vegetable or fruit fibers. A case of Phytobezoar causing acute small intestinal obstruction in absence of prior gastric surgery or other predisposing factors is presented. The patient was managed surgically i.e., enterotomy

Tricotilomanía, tricobezoar de repetición y síndrome de Rapunzel: informe de un caso y revisión de la literatura / Trichotillomania, recurrent trichobezoar and Rapunzel syndrome: case report and literature review

Introducción: Un bezoar es un conglomerado de material extraño en el tracto intestinal. El tricobezoar (acumulación de cabello en la cámara gástrica) y el síndrome de Rapunzel (acumulación en el intestino delgado) suelen aparecer en niños y mujeres adolescentes con antecedente de tricotilomanía y tricofagia. Caso clínico: Mujer de 22 años de edad con dolor abdominal intermitente, plenitud gástrica, náuseas, vómito ocasional y pérdida ponderal de 10 meses de evolución. Antecedentes de tricotilomanía, tricofagia y gastrotomía a los 16 años. Los exámenes de laboratorio revelaron anemia microcítica hipocrómica y el ultrasonido mostró una sombra sónica posterior en la cámara gástrica. Por gastrotomía se extrajo un conglomerado de cabello que ocupaba el estómago y parte del intestino delgado. Conclusiones: La tricotilomanía y tricofagia son más comunes en las mujeres menores de 30 años. La sensación que experimentaba la paciente al deglutir los cabellos provocaba la ingesta. La recopilación de datos puede proporcionar información acerca de los determinantes que influyen en la aparición de la enfermedad.

BACKGROUND: Bezoar is a conglomeration of foreign material in the intestinal tract. Trichobezoar (accumulation of hair in the gastric chamber, secondary to impulsive pulling and intake) and Rapunzel syndrome (accumulation of hair in the small intestine) usually occur in children and adolescents with trichotillomania (TTM) and trichophagia history. CLINICAL CASE: We present the case of a 22-year-old female who arrived for consultation. The patient had a 10-month history of intermittent abdominal pain, gastric fullness, nausea, occasional vomiting and weight loss. In addition, she had a history of TTM, trichophagia and previous gastrotomy at 16 years of age. Laboratory tests revealed hypochromic microcytic anemia. Ultrasonographic study demonstrated intense sonic shadowing posterior to the gastric area. After performing gastrotomy, the specimen was extracted and consisted of hair that occupied the entire length of the gastric chamber and part of the small intestine. CONCLUSIONS: TTM is characterized by recurrent and impulsive pulling of one's hair for pleasure, gratification, or relief of tension. Children and women <30 years of age are the groups who most frequently suffer from this type of disorder. Hair intake sensation was a cause for presentation of the disease. Data recollection in our environment may provide information for the determination of new information regarding the presence of this condition.

Tricobezoar na infância: relato de três casos e revisão da literatura / Trichobezoar in children: report of three cases and review of literature

Tricobezoares são corpos estranhos gástricos compostos por cabelos dos próprios pacientes. São mais comuns em crianças, principalmente do sexo feminino. Cursam freqüentemente com sintomas gastrintestinais como dor abdominal, náuseas, vômitos, anorexia, perda de peso e plenitude pós-prandial. Massa epigástrica, alopécia e antecedentes de tricofagia podem estarpresentes. O tratamento de eleição é o cirúrgico, acompanhado de tratamento psiquiátrico. Este trabalho tem como objetivo relatar três casos de pacientes com tricobezoar gástrico e realizar uma revisão da literatura. Todos os casos deste estudo eram de crianças dosexo feminino. Dois pacientes cursaram com quadro de suboclusão intestinal, apresentando dor abdominal evômitos. Em um caso havia dor abdominal não acompanhada por vômitos. Todos apresentaram antecedentes de tricofagia, bem como massa epigástrica palpável. Um com áreas de alopécia. O principal examede imagem empregado foi a seriografiaesofagogastroduodenal. Todos foram submetidos a tratamento cirúrgico mediante gastrotomia e encaminhados para serviço de psicologia, com boaevolução clínica.

Trichobezoars are concretions of ingested hair that most often lodge in the stomach. They are commonlyseen in young girls with psychiatric disorders. Upper gastrointestinal symptoms usually are progressive andmay include abdominal pain, nausea and vomiting, early satiety, weight loss, bloating, diarrhea or constipation. Ahistory of tricophagia is common. Physical examination may include the presence of nontender palpable massand bald spot. Gastric trichobezoars require removal through an anterior gastrotomy. Postoperatively, psychiatric intervention is often appropriate. The purpose of this study was to describe three cases of patients with gastric trichobezoar and make a review of literature. All patients studied were yo ung girls. Two patients presented abdominal pain and vomiting. In one case there was abdominal pain without vomiting. All cases presented tricophagia and palpable mass. One had bald spot. Barium contrast study was the most beneficial in the diagnosis. In our cases, bezoars were removed easily via single gastrotomy. Postoperatively they were evaluated by psychology. The remainder of their hospital course wasunremarkable.

Plasticobezoar-another new entity for Rapunzel syndrome.

Rapunzel syndrome- a form of trichobezoar occurs when a gastric trichobezoar extends beyond the pylorus into the bowel. We report two cases of Rapunzel syndrome, one of them caused by ingestion of plastic material, so as to name it as a 'Plasticobezoar'. To the best of our knowledge no Rapunzel syndrome due to this material has been reported so far.

Obstrucción intestinal causada por tricobezoar: Síndrome de Rapunzel / Intestinal obstruction due to a tríchobezoar or Rapunzel Syndrome: report of one case

Rapunzel syndrome or gastrointestinal trichobezoar is caused by hair ingestion. The diagnosis may be suspected in young females with important weight loss, who deny hair eating. We report a 16 year-old female consulting in the emergency room for abdominal pain. She was subjected to an exploratory laparotomy and a big mass was palpated in the stomach. A gastrostomy and enterostomy were performed and a 17x6x5 cm trichobezoar was extracted. The patient had an uneventful postoperative outcome and was derived to Psychiatry.

Acute Intestinal Obstruction Caused by a Persimmon Phytobezoar after Dissolution Therapy with Coca-Cola

Bezoars are concretions or hard masses of foreign matter that are found in the gastrointestinal tract. Recent reports have demonstrated the efficacy of Coca-Cola administration for the dissolution of phytobezors. Here we report on a 73-year-old man with a very large gastric persimmon diospyrobezoar, and this caused small intestinal obstruction after partial dissolution with oral and injected Coca-Cola.

Phytobezoar as a late complication of vertical banded gastroplasty

In the last two decades, bariatric surgery has become a popular mean for treating morbid obesity. Although the newer procedures are claimed to have less complications than the older ones, the world is still at a learning curve. Numerous complications of this surgery are known and require recognition to be appropriately treated. Phytobezoar is one of the rare late complications following Bariatric surgery and various factors can contribute to its development including hypochlorhydria, diminished antral motility, and incomplete mastication. The case being presented is a rare case of gastric outlet obstruction due to phytobezoar almost two years following vertical banded gastroplasty. The patient was successfully treated with Sodium Docusate, which is a faecal softener and weak stimulant laxative. To our knowledge, this is the first case report presenting such a complication following vertical banded gastroplasty. Phytobezoar should be considered in the differential diagnosis of epigastric symptoms in patients with a history of gastric surgery. Sodium docusate was an effective medical therapy in this patient