Small bowel obstruction after endoscopic fragmentation of a gastric bezoar: An unexpected complication

Nunes, Gonçalo; Patita, Marta; Barosa, Rita; Canhoto, Manuela; Ramos, Lídia Roque; Lages, Patrícia; Fonseca, Jorge

doi:10.5152/tjg.2018.18029

Cited by 3 publications

(3 citation statements)

References 7 publications

(5 reference statements)

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“…This technique is well reported across the literature though appears to be less effective with persimmon bezoars due to tannin agglutination and their rough consistency 6. Endoscopic treatment can involve spraying of a lytic substance onto the bezoar or fragmentation under vision though this carries the risk of downstream obstruction secondary to incomplete fragmentation 12. Intraoperative endoscopy can also be used to find and map the obstructing bezoars from an intraluminal perspective given it can be difficult to identify these masses purely on tactile assessment of the stomach and gastrointestinal tract.…”

Section: Discussionmentioning

confidence: 99%

Small bowel obstruction caused by dehydrated apple ingestion: the challenges of preoperative radiological diagnosis and surgical management

Mikhail,

McKay,

Goodwin

et al. 2024

BMJ Case Rep

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A man in his 60s with a virgin abdomen presented with sudden-onset generalised abdominal pain and fevers. The night prior, he snacked on supermarket purchased dehydrated apples. CT abdomen and pelvis revealed small bowel obstruction (SBO) to the mid ileum and small amount of free fluid within the pelvis. The patient underwent emergency exploratory laparotomy. High-grade SBO was identified, caused by large obstructing phytobezoars, with three further proximal large phytobezoars identified. All four phytobezoars were extracted and found to be rehydrated pieces of dehydrated apple that had increased in size in the gastrointestinal tract. The patient was later found to have further phytobezoars in the stomach which passed conservatively. The patient recovered well. This case demonstrates the challenges of preoperative radiological diagnosis in phytobezoar-related SBO and the significance of enterotomy orientation and closure to ensure a safe repair to withstand the passage of any residual rehydrating phytobezoars.

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Section: Discussionmentioning

confidence: 99%

Small bowel obstruction caused by dehydrated apple ingestion: the challenges of preoperative radiological diagnosis and surgical management

Mikhail,

McKay,

Goodwin

et al. 2024

BMJ Case Rep

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“…1. Abdominal X-ray at presentation or leaving the fragmented mass for natural evacuation via the gastrointestinal tract (6) . However, these less invasive methods have limited application in intestinal obstruction and a large mass.…”

Section: Discussionmentioning

confidence: 99%

Recurrent trichobezoar in a patient with Rapunzel syndrome

Godlewska¹,

Orpiszewska²,

Górecki³

2021

Pediatr Med Rodz

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Rapunzel syndrome is a condition where a trichobezoar is formed in the stomach and proximal intestine due to hair ingestion. A 6-year-old girl presented to emergency department with abdominal pain, vomiting and a palpable epigastric mass. Laparotomy was performed for gastric foreign body; a trichobezoar that filled the stomach, duodenum and proximal small intestine was removed. Postoperative course was uncomplicated; the patient was discharged for further out-patient follow-up and psychological care. After 7 months, the girl presented with a recurrence. A recurrent trichobezoar was removed via laparotomy. The girl was started on psychiatric treatment and iron substitution for anaemia. Ten weeks after discharge, follow-up gastroscopy was negative for gastric foreign body. There are no guidelines for follow-up after trichobezoar removal. Since the disease may be recurrent, follow-up endoscopy should be considered in order to enable an early diagnosis and less invasive treatment.

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“…Treatment includes chemical dissolution with agents like CocaCola ® or acetylcysteine, prokinetics, endoscopic removal, and surgery. Endoscopic therapy involves fragmenting the bezoar using different mechanisms, most commonly forceps, snares, baskets, and argon plasma coagulation [1]. Although endoscopic treatment is not standardized, a minority of cases managed using laser lithotripsy were reported [2][3][4][5].…”

mentioning

confidence: 99%

Endoscopic Extraction of Two Giant Stone Bezoars Using Mechanical and Laser Lithotripsy

Oliveira,

Nunes,

Vara-Luiz

et al. 2023

GE Port J Gastroenterol

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Small bowel obstruction after endoscopic fragmentation of a gastric bezoar: An unexpected complication

Cited by 3 publications

References 7 publications

Small bowel obstruction caused by dehydrated apple ingestion: the challenges of preoperative radiological diagnosis and surgical management

Small bowel obstruction caused by dehydrated apple ingestion: the challenges of preoperative radiological diagnosis and surgical management

Recurrent trichobezoar in a patient with Rapunzel syndrome

Endoscopic Extraction of Two Giant Stone Bezoars Using Mechanical and Laser Lithotripsy

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