Acute pancreatitis and small bowel obstruction caused by a migratory gastric bezoar after dissolution therapy: A case report

Abstract

BACKGROUND Bezoars are conglomerates of indigestible foreign material that can be found in the gastrointestinal tract. Gastric ulcer, gastrointestinal perforation, and intestinal obstruction are the main complications. Acute pancreatitis secondary to bezoar is rare. Here, we present a rare case of a migratory gastric bezoar complicated by acute pancreatitis and small bowel obstruction after dissolution therapy. CASE SUMMARY A-65-year-old woman underwent gastroscopy because of epigastric pain, which revealed a huge bezoar and a gastric ulcer 10 d prior. The patient was discharged with a prescription of drinking 1 L Coca-Cola daily for 6 d, without repeat gastroscopy. However, she suddenly developed epigastric pain, nausea and vomiting for 3 d. Abdominal computed tomography (CT) revealed mild inflammation of the pancreas. Magnetic resonance cholangiopancreatography showed no abnormalities in the pancreatic duct or common bile duct. The nasogastric tube still showed drainage of more than 1.6 L of dark fluid each day after symptomatic treatment. Abdominal CT re-examination suggested intestinal obstruction. Esophagogastroduodenoscopy revealed a huge yellowish hard mass in the jejunal lumen, and we used the basket and net to fragment the bezoar. She was discharged with a good outcome. CONCLUSION Endoscopic therapy is the first choice for gastric bezoars. When mechanical disintegration cannot be achieved, timing of repeat endoscopy is important during Coca-Cola dissolution therapy.

Intestinal Obstruction Due to Reassembly after Endoscopic Crushing of a Bezoar

“…Another report detailed a case of a small bezoar obstructing the papilla of Vater and causing pancreatitis ( 12 ), and since the obstruction in our case was in the duodenal bulb, our patient was also at risk of developing pancreatitis.…”

Successful laparoscopic extraction of trichobezoar due to Rapunzel syndrome: first reported case in Kuwait

“…In our case, the patient presented with acute abdominal pain with a CT scan suggestive of small bowel obstruction. Elevation of lipase and amylase was due to migration of the bezoar to the ampulla of Vater, causing spasms and congestion of the sphincter of Oddi, resulting in bile regurgitation and trypsin activation once the pressure in the bowel was higher than in the pancreatic duct [ 11 ]. Diagnosis of trichobezoar can be made by ultrasound, CT scan, barium meal and endoscopy.…”

Tannin-phytobezoars with Gastric Outlet Obstruction Treated by Dissolution with Administration and Endoscopic Injection of Coca-Cola^®, Endoscopic Crushing, and Removal (with Video)

“…In particular, treating gastric tannin-phytobezoars, caused by the frequent consumption of persimmon, through Coca-Cola Ⓡ dissolution therapy has often been considered first, as it is easy, safe, and cost-effective to perform ( 9 , 10 ). However, there have been reports of Coca-Cola Ⓡ -reduced bezoar causing small intestine obstruction, which resulted in ileus and acute pancreatitis ( 3 , 4 ). Therefore, it is more reliable and safer to remove the bezoars directly with an endoscope before they migrate to the duodenum.…”