Pharmacobezoar—a rare case presented as gastric outlet obstruction

Abstract

BEZOARS are retained concretions of indigestible foreign material that accumulate and conglomerate in the gastrointestinal tract, most commonly in the stomach. Prevalence of bezoar is 0.4%. Bezoars are classified in four categories: phytobezoars; trichobezoars; pharmacobezoars; lactobezoars. A 58-year-old man admitted with complains of pain abdomen and recurrent vomiting since last 3 months. Upper GI endoscopic biopsy reported—chronic gastritis with very occasional non-caseating epitheloid granuloma in lamina propria, no evidence of neoplasia? Crohn’s disease. Keeping Crohn’s as diagnosis patient was given mesalamine 400 mg tid by gastrophyscian. But patient did not respond so the patient was advised surgical management. Repeat UGI endoscopy revealed multiple pills (mesalamine) in the stomach with gastric outlet obstruction (GOO). Around 40 pills were extracted with the help of flower basket, and then patient develope GOO and underwent Laparoscopic gastrojejunostomy and truncal vagotomy.

Upper Gastrointestinal Manifestation of Bezoars and the Etiological Factors: A Literature Review

“…Because of the advancement of technology and time delivery-facilitated drug tablets/capsules to be slowly dissolved and gradually release active ingredients of the medication, extended-release medicines, e.g., nifedipine and verapamil, are coated with cellulose acetate; cellulose acetate may amass and lead to the progression of gastric bezoar [6]. Moreover, aluminum hydroxide gel, enteric-coated aspirin, sucralfate, cholestyramine, enteral feeding formulas, mesalamine pills, and meprobamate appear to contribute to the development of pharmacobezoars [47, 48]. Furthermore, a case by Croitoru et al [10] reported a sodium polystyrene sulfonate gastric bezoar in a patient who mechanically ventilated after cardiopulmonary resuscitation secondary to pericarditis, primary lung cancer, and kidney failure with concomitant hyperkalemia.…”

“…The etiology of pyloric stenosis is complex, with some genetic and some environmental factors. Adults with pyloric stenosis may be due to the idiopathic hypertrophic pylorus [37] or related to underlying gastric pathology such as recurrent peptic ulcers, malignancy, and hypertrophic gastritis that weakens gastric emptying into the duodenum; as a result, all consumed foodstuff stuck in the stomach due to the pyloric obstruction and developed gastric mass [48]. Pyloric obstruction can also be a result of Bouveret's syndrome [24] and bacterial infection of the gastric wall or gastric wall abscess after cholecystitis [26].…”

Stomach Bezoaris, Causes of Development, Diagnosis and Methods of Treatment

“…Phytobezoаr is the most common type of bezoar, which occurs in about 75 % of all types of bezoar, and is formed as a result of the use of a large number of bezorogenic products of plant origin, including grapes, persimmon (diospirobesoar), dates, figs, dogwood, cherries and sweet cherries, corn, pineapple [1,2,3]. Such types are also distinguished: lactobesoir -accumulation of lactose and casein (is common for children) [4]; pharmacobezoir -caused by the use of tableted drugs [5], which include: aluminum hydrochloride gel, intestinal aspirin, sucralfate, cholestyramine, nifedipine [6,7]; Sebobezoar -is formed by refractory animal fats in the form of fatty conglomerates, shellacobezoar (or pixo-or desmobezoar) -resins and bitumen [1,8]; trichobezoar -the aggregation of hair between the folds of the stomach [9,10], which occurs more often in women up to 30 years [11], is associated with mental illness and bad habits: trichotomomania (tearing hair) and trichophagia (swallowing hair), it can "tail" spread to the intestine (Rapunzel syndrome) [12]; polybezoar -mixed genesis [1,8].…”

Observation on the curative effect of long intestinal tube in the treatment of phytobezoar intestinal obstruction

“…Bezoars grow due to the ingestion and accumulation of undigested material. Bezoars can be classified into 4 types based on their components [ 1 – 4 ] : a phytobezoar is one type of bezoar, a concretion of undigested particles that usually forms in the stomach, and descends through the digestive tract where small bowel obstruction can result. A trichobezoar is composed of hair, and is associated with psychiatric disorders such as trichotillomania.…”