Esophageal obstruction due to enteral feed bezoar: A case report and literature review

Marcus, Esther‐Lee; Arnon, Ron; Sheynkman, Arkadiy; Caine, Yehezkel; Lysy, Joseph

doi:10.4253/wjge.v2.i10.352

Cited by 31 publications

(20 citation statements)

References 26 publications

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“…We also recommend daily assessment of feeding tube position, feeding in a semi-recumbent position, administration of prokinetic agents and proton pump inhibitors as preventative measures [10]. If feasible tube feeding should be done with nasoduodenal or nasojejunal tubes rather than orogastric or nasogastric tubes.…”

Section: Discussionmentioning

confidence: 99%

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Esophageal Obstruction Associated with Enteral Feedings with Nepro?: an Unreported Event

Singh¹,

BThapamagar²,

Mukherjee³

2013

J Gastrointest Dig Syst

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We report a unique case of esophageal obstruction related to orogastric (OG) tube feedings with Nepro. The patient was an 84 year old male who was on mechanical ventilation for severe respiratory distress. He was started on Nepro ® via an OG tube. Seven days later, while reinserting the OG tube, an esophageal obstruction was identified. On the same day, esophago-gastroduodenoscopy was done for esophageal disimpaction. Subsequently, we concluded that the Nepro® feed, which precipitated and solidified, caused obstruction of the entire esophagus. We report that Nepro® feeds have the property of solidifying and causing obstruction especially in recumbent patients who do not have the benefit of gravity for food propulsion. Such obstructions have been reported for other enteral nutrition formulations, but to the best of our knowledge, this is the first reported case for Nepro® and hence it should be added to the list of complications.

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Section: Discussionmentioning

confidence: 99%

“…We should also be aware of possible migration of feeding tubes during daily patient care to prevent esophageal feeding. We should also be aware of other predisposing factors such as mechanical ventilation, supine position, neurological diseases, diabetes mellitus, hypothyroidism, obesity and history of partial gastrectomy [10].…”

Section: Discussionmentioning

confidence: 99%

Esophageal Obstruction Associated with Enteral Feedings with Nepro?: an Unreported Event

Singh¹,

BThapamagar²,

Mukherjee³

2013

J Gastrointest Dig Syst

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“…4). Intraintestinal formation of a large object is best known in form of a bezoar made up of many small foreign bodies, like in "Rapunzel syndrome", when the object is made up of the patient's own hair [1], although bezoars also occur with other material [2]. The psychiatric disorder in our patient suggested intentional ingestion of the liquid.…”

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confidence: 95%

A drinkable foreign body: acrylated resin

et al. 2012

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A 65-year-old schizophrenic patient had ongoing epigastric pain. Gastroscopy revealed a large foreign body (• " Fig. 1). Endoscopic fragmentation and retrieval were impossible (• " Fig. 2). The patient denied having ingested the object, which, considering its size, was plausible. The foreign body was not dissolvable, causing symptoms and a risk of intestinal obstruction or perforation. Surgical removal was necessary (• " Video 1). A laparoscopic gastrotomy of the anterior gastric wall to harvest the object (• " Fig. 3) was followed by removal through a lengthened trocar incision in a retrieval bag. The gastrotomy was sutured laparoscopically. Postoperative recovery was uneventful. Physicochemical analysis of the object revealed it to be acrylated resin. The patient then admitted to "accidentally" having drunk clear paint. The chemicals contained in the paint hardened in the stomach forming a solid foreign body (• " Fig. 4). Intraintestinal formation of a large object is best known in form of a bezoar made up of many small foreign bodies, like in "Rapunzel syndrome", when the object is made up of the patient's own hair [1], although bezoars also occur with other material [2]. The psychiatric disorder in our patient suggested intentional ingestion of the liquid. Concealment of the facts by patients is common with deliberate foreign body ingestion [3]. Ingestion of foreign material in adults is usually intentional [3], sometimes suicidal. Paint has been used successfully to commit suicide [4]. Clinical management of ingested foreign bodies is well described [5]. Many objects pass naturally, but the rate of surgical intervention reaches 16 % [5]. Endoscopy should not delay surgical consultation. Unusual in this case is that a liquid, in the stomach, becomes a solid object which could not have been swallowed as such. A laparoscopic approach can be a safe and efficient way to minimize trauma and minimize recovery time for the removal of such a large intestinal foreign body.

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“…Bezoar dissolution via liquid and nutritional diets is a slow process and is not preferred as a sole therapy. Fiber-containing bezoars can be partially influenced by proteolytic enzymes (papain, Viokase), while up to 85% of the phytobezoars can be successfully degraded enzymatically by cellulase formulations and the mucolytic agent N-acetylcysteine [72]. Aggressive lavage (water, coca-cola, and pineapple juice [73, 74]) and subsequent aspiration of the fragmented concretions is an appropriate approach for soft and permeable bezoars.…”

Section: Introductionmentioning

confidence: 99%

Gastric Electrical Stimulation for the Treatment of Obesity: From Entrainment to Bezoars—A Functional Review

Mintchev

2013

ISRN Gastroenterology

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Growing worldwide obesity epidemic has prompted the development of two main treatment streams: (a) conservative approaches and (b) invasive techniques. However, only invasive surgical methods have delivered significant and sustainable benefits. Therefore, contemporary research exploration has focused on the development of minimally invasive gastric manipulation methods featuring a safe but reliable and long-term sustainable weight loss effect similar to the one delivered by bariatric surgeries. This antiobesity approach is based on placing external devices in the stomach ranging from electrodes for gastric electrical stimulation to temporary intraluminal bezoars for gastric volume displacement for a predetermined amount of time. The present paper examines the evolution of these techniques from invasively implantable units to completely noninvasive patient-controllable implements, from a functional, rather than from the traditional, parametric point of view. Comparative discussion over the available pilot and clinical studies related to gastric electrical stimulation outlines the promises and the fallacies of this concept as a reliable alternative anti-obesity strategy.

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Esophageal obstruction due to enteral feed bezoar: A case report and literature review

Cited by 31 publications

References 26 publications

Esophageal Obstruction Associated with Enteral Feedings with Nepro?: an Unreported Event

Esophageal Obstruction Associated with Enteral Feedings with Nepro?: an Unreported Event

A drinkable foreign body: acrylated resin

Gastric Electrical Stimulation for the Treatment of Obesity: From Entrainment to Bezoars—A Functional Review

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