Successful endoscopic treatment of an intestinal diospyrobezoar migrated from the stomach

Abstract

SUMMARY Diospyrobezoars are a rare cause of small intestinal obstruction. A 78-year-old man, with a history of persimmons ingestion and gastrectomy, presented with upper abdominal pain and weight loss. The upper gastrointestinal endoscopy showed a huge bezoar in the stomach. After initial endoscopic fragmentation, the abdominal X-ray revealed intestinal obstruction and the colonoscopy showed large fragments of the bezoar filling the terminal ileum. The migrated bezoar pieces were successfully removed by endoscopic fragmentation with a cutting lithotripter. BACKGROUND

Pathophysiological and clinical aspects of the diagnosis and treatment of bezoars

“…when treated with excessive amounts of CC. Moreover, pieces from bezoar fragmentation may obstruct the pyloric outlet and/or migrate to the small bowel causing ileus [59,60]. Therefore, more studies are needed to assess and establish this method.…”

Endoscopic treatment for a giant gastric bezoar: Sequential use of electrohydraulic lithotripsy, alligator forceps, and snares

“…Endoscopic fragmentation was performed using the snare and alligator device. The third considerable point was to crush the huge bezoar to pieces to prevent small bowel obstruction after parts of the crushed bezoar flowed into the small intestine 6 . The combined use of alligator forceps and snares was also effective in crushing the large bezoar to pieces to prevent small bowel obstruction caused by residual bezoars.…”

“…Adverse events after endoscopic therapy, such as intestinal obstruction caused by residual bezoars, have also been reported. Therefore, careful strategic planning is required to prevent adverse events 6 . Here, we report our experience of endoscopically treating a giant gastric bezoar with a variety of instruments without complications.…”

“…2 Recent advancements in endoscopic modalities have enabled the application of several endoscopic therapies for the treatment of gastric bezoars. [3][4][5][6][7] Although there are no established methods for the treatment of gastric bezoars, there are reports of endoscopic treatment using dual knife, electric snare, and guidewire. Adverse events after endoscopic therapy, such as intestinal obstruction caused by residual bezoars, have also been reported.…”

Endoscopic versus Surgical Intervention for Jejunal Bezoar Formation

“…There are only a few case reports documenting successful endoscopic removal of intestinal bezoars. One such case involved a terminal ileum bezoar treated with colonoscopic fragmentation,21 , 22 and the other a proximal jejunal phytobezoar fragmented via antegrade double-balloon enteroscopy (DBE) 23…”