Gastric surgery and bezoars

Abstract

We present a series of 56 patients with gastrointestinal bezoar following previous gastric surgery for gastroduodenal peptic ulcer. The following parameters were studied: factors predisposing to bezoar formation (type of previous surgery, alimentation, and mastication), form of clinical presentation, diagnostic tests, and treatment. A bilateral truncal vagotomy plus pyloroplasty had been performed previously on 84% of patients, 44% revealed excessive intake of vegetable fiber, and 30% presented with bad dentition. The most frequent clinical presentation was intestinal obstruction (80%). This was diagnosed mainly by clinical data and simple abdominal radiology. The main exploratory technique for diagnosing cases of gastric bezoar was endoscopy. Surgery is necessary for treating the intestinal forms, and one should always attempt to fragment the bezoar and milk it to the cecum, reserving enterotomy and extraction for cases where this is not possible. The small intestine and stomach should always be explored for retained bezoars. Gastric bezoars should always receive conservative treatment, endoscopic extraction, and/or enzymatic dissolution; gastrotomy and extraction should be performed when this fails.

Phytobezoar impaction in a Meckel’s diverticulum; a rare cause of bowel obstruction: Case report and review of literature

“…The most common complication of Meckel’s diverticulum in adults is intestinal obstruction [2]. It can result from several mechanisms commonly described in medical books such as; volvulus of the intestine around the fibrous band attaching the diverticulum to the umbilicus, intussusception with a diverticulum acting as lead point, entrapment of the intestine by a mesodiverticular band and strictures secondary to chronic diverticulitis [3]. Phytobezoar is a vegetable ball defined as a concentration of poorly digested vegetables and fruit fibers that is found in alimentary tract in particular in the stomach commonly causing symptoms varying from dyspepsia to epigastric mass.…”

Phytobezoar in Meckel's diverticulum: A rare cause of small bowel obstruction

“…In our report the phytobezoar Meckel's diverticulum obstruction could have been related either to ethnic alimentary habits (Chinese food) 7,8 or to concomitant pathology (diabetes). 10 Our patient underwent explorative urgent laparotomy that confirmed the obstruction due to distended Meckel's diverticulum phytobezoar that induced small bowel compression, ending up with a clinical and radiological small bowel obstruction.…”

“…For instance in China and Spain the Authors report high rate of gastrointestinal bezoars related to consumption of persimmon, oranges and mushroom. 7,8 Other factors include previous gastric surgery, poor mastication, and overindulgence of foods with high fibre contents 9 as well as delayed gastric emptying because of diabetes, mixed connective tissue disease or hypothyroidism. 10 Patients can be completely asymptomatic or with different clinical patterns.…”

Successful endoscopic treatment of an intestinal diospyrobezoar migrated from the stomach

“…Although the aetiology is undefined, history of gastric surgery and delayed gastric emptying are risk factors 3. Small intestinal obstruction caused by a diospyrobezoar is usually caused by migration of a gastric bezoar 2.…”