A Single Tertiary Center 10-Year Experience in the Surgical Management of Gastrointestinal Bezoars

Horesh, Nir; Rosin, Danny; Dreznik, Yael; Amiel, Imri; Jacoby, Harel; Nadler, Roy; Gutman, Mordechai; Klang, Eyal

doi:10.1089/lap.2017.0752

Cited by 9 publications

(7 citation statements)

References 19 publications

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“…Notably, laparoscopic surgery is performed only in properly equipped medical centers; it requires technical experience and detailed preoperative evaluation (clinical, radiological, endoscopic). Meticulous preoperative study is necessary, because dilated intestinal loops, adhesion from previous operations, multiple bezoars or even worse complications (including perforation and/or peritonitis) may jeopardize or prevent the laparoscopic approach [68,69]. Interestingly, laparoscopy offers better-magnified visualization of the whole abdomen (although palpation is not possible), as well as fewer complications and a shorter hospital stay when it is properly performed by experienced surgeons [70].…”

Section: Therapeutic Approachmentioning

confidence: 99%

Pathophysiological and clinical aspects of the diagnosis and treatment of bezoars

Paschos

Chatzigeorgiadis

2019

aog

106

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Bezoars are intraluminal conglomerates of indigestible foreign materials that accumulate in the gastrointestinal (GI) tract. They consist of vegetable or fruit fibers, hairs or other substances; accordingly, bezoars are classified as phytobezoars, trichobezoars, pharmacobezoars, etc. Although sometimes asymptomatic, bezoars may cause serious symptoms, such as abdominal discomfort or pain, dysphagia, hematemesis, or even life-threatening entities (GI bleeding, obstruction or perforation). Current technological applications have contributed to the diagnostic and therapeutic approach to these masses, mainly through endoscopic techniques able to diagnose, fragment and extract bezoars, as well as laparoscopic and other surgical modalities that may be used to treat serious complications. Although bezoars were described centuries ago and the term was officially introduced in the mid nineties by Quain, they are still a demanding pathological entity. Their pathophysiology, accurate and prompt diagnosis, as well as successful and minimally invasive treatment, remain under investigation and see continuous progress. Current advances in these challenging areas are discussed in this review, which attempts to present an in-depth study of bezoars along with the well-established modalities and techniques.

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Section: Therapeutic Approachmentioning

confidence: 99%

Pathophysiological and clinical aspects of the diagnosis and treatment of bezoars

Paschos

Chatzigeorgiadis

2019

aog

106

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“…In a review by Gorter et al [ 6 ] laparotomy had a success rate of 99%, with a 12% complication rate, whereas laparoscopy was successful in 75% of the cases, with no complications. Horesh et al [ 25 ] reported a 55% conversion rate to an open procedure after a laparoscopic approach and found no benefit in the complication rate, readmissions, and length of stay. Due to a high success rate, the low complication rate, and low complexity, and the ability to examine the gastrointestinal tract, the surgical approach through a laparotomy is still considered the treatment of choice for trichobezoars [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Small-Bowel Obstruction Secondary to Ileal Trichobezoar in a Patient with Rapunzel Syndrome

García-Ramírez

Nuño-Guzmán

Zaragoza-Carrillo

et al. 2018

Case Rep Gastroenterol

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Bezoars are conglomerations of undigested foreign material retained in the gastrointestinal tract. Trichobezoar is a compact conglomeration of swallowed hair and constitutes less than 6% of all bezoars. Their most frequent location is in the stomach but they may extend through the pylorus into the small bowel. This condition is known as Rapunzel syndrome. Many patients may remain asymptomatic or present a mild form of the disease characterized by abdominal pain, early satiety, nausea, and vomiting. Complications may manifest as gastric outlet obstruction or bleeding, and intestinal obstruction. A 15-year-old female patient presented with clinical findings of intestinal obstruction. The patient suffered from depressive and anxiety disorders and trichotillomania, although trichophagy could not be assured. Alopecia circumscripta and irregular hair length on the scalp were identified. A computed tomography (CT) scan showed two images highly suggestive of trichobezoars, one in the stomach and the second one causing obstruction at the ileocecal valve. At laparotomy, both a mobile gastric trichobezoar with a tail extending to the duodenum and a trichobezoar causing obstruction at the ileocecal valve were removed. The postoperative course was uneventful. The passage of a detached trichobezoar fragment in a patient with Rapunzel syndrome may cause intestinal obstruction. CT is the preferred image modality for the evaluation of suspected trichobezoars in order to characterize their size and locations, the presence and level of obstruction, and complications such as ischemia or perforation. A case of small-bowel obstruction secondary to ileal trichobezoar in a patient with Rapunzel syndrome is herein reported.

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“…The majority of ingested FBs typically resolve with conservative management. However, endoscopic and surgical intervention may be necessary in up to 87% of patients presenting with peritonism or obstruction 4,5,9 . Therefore, timely identification of FB‐induced SBO is warranted to prevent complications.…”

Section: Figurementioning

confidence: 99%

“…However, endoscopic and surgical intervention may be necessary in up to 87% of patients presenting with peritonism or obstruction. 4,5,9 Therefore, timely identification of FB-induced SBO is warranted to prevent complications. Although conventional surgical management involves laparotomy, laparoscopy may be used as a safe alternative in patients without prior surgical history.…”

Section: Unusual Cause Of Recurrent Small Bowel Obstruction In An Incarcerated Patient: Ingested Plastic Foreign Bodiesmentioning

confidence: 99%

Unusual cause of recurrent small bowel obstruction in an incarcerated patient: ingested plastic foreign bodies

Yip

Sidhu

Noori

et al. 2020

ANZ Journal of Surgery

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patient demonstrates a unique case in which small bowel obstruction is secondary to extrinsic compression from a mesenteric haematoma, rather than progressive ischaemia secondary to a vascular injury leading to luminal stricturing.In our review of the English literature, all cases of delayed small bowel obstruction following blunt abdominal trauma have been managed operatively. [1][2][3][4][5][6][7] Operative management is clearly indicated in patients who are haemodynamically unstable or demonstrate evidence of an acute abdomen; however, there is an argument to proceed with non-operative management in stable patients. The decision to manage these patients conservatively poses a difficult clinical scenario, particularly when obstruction can occur months following the initial blunt injury. 5 Whilst we should have a high clinical suspicion for the possibility of stricture formation following mesenteric injury, which is unlikely to resolve non-operatively, it is important to manage patients according to their clinical and radiological findings. In a setting where obstruction is secondary to extrinsic compression rather than stricturing, it can be inferred that this obstruction will be relieved as the haematoma liquefies. We propose that in patients with extrinsic small bowel compression leading to obstruction, the reduced morbidity of pursuing nonoperative management is a viable option.This case demonstrates a unique presentation of small bowel obstruction secondary to extrinsic compression by a mesenteric haematoma. Despite literature indicating that patients with small bowel obstruction secondary to blunt abdominal trauma often require operative management, we highlight a patient in which conservative management with decompression resulted in a successful outcome.

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A Single Tertiary Center 10-Year Experience in the Surgical Management of Gastrointestinal Bezoars

Abstract: GI bezoars require surgical intervention at high rates. Postoperative complications are common. Completion of an upper GI endoscopy is important and should be performed at an early stage of management.

Cited by 9 publications

References 19 publications

Pathophysiological and clinical aspects of the diagnosis and treatment of bezoars

Pathophysiological and clinical aspects of the diagnosis and treatment of bezoars

Small-Bowel Obstruction Secondary to Ileal Trichobezoar in a Patient with Rapunzel Syndrome

Unusual cause of recurrent small bowel obstruction in an incarcerated patient: ingested plastic foreign bodies

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