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At least 19 recordsLinked to original sources
PubMed1981

Medication bezoar: intestinal obstruction by an isocal bezoar. Case report and review of the literature.

Medications may occasionally obstruct the gastrointestinal tract by virtue of their physical mass. Obturative obstruction of the alimentary tract is reportedly caused by an increasing number of medications, including hydroscopic bulk laxatives, cholestyramine, nonabsorbable antacids, and vitamin C tablets. Inspissated Isocal tube feedings caused jejunal obstruction in a postoperative patient. Medication bezoars are a rare cause of intestinal obstruction that may result in significant patient morbidity, including bowel necrosis, perforation, and peritonitis. The radiographic appearance may mimic an abdominal abscess.

Adult↗
PubMed1998

Medication bezoars: a literature review and report of a case.

OBJECTIVE: To describe a case of a medication bezoar and to review the clinical presentation, diagnosis, risk factors, pathogenesis, complications, and treatment of medication bezoars. DATA SOURCES AND STUDY SELECTION: A MEDLINE search (January 1966-December 1997) of the English-language literature pertaining to bezoars was performed. These articles were scanned, and literature specifically discussing medication bezoars was selected. Additionally, the reference sections of pertinent review and case reports were scanned for additional relevant literature. DATA SYNTHESIS: Bezoars are concretions of foreign material within the body. In the case of medication bezoars, these concretions occur within the digestive tract and are composed of medications and/or medication vehicles. Rarely, however, is bezoar formation solely due to a medication. In nearly all reported cases the patient had one or more significant risk factors that contributed to bezoar formation. The exact method by which medications bezoars form is dependent on the particular type or combination of medications involved. Bezoar formation may be associated with significant complications for the patient due to the presence of the bezoar and because of the effects of the medication within the bezoar. Treatment of medication bezoars depends largely on the location and the cause of the bezoar. CONCLUSIONS: Medication bezoars are a rare but potentially serious complication of medication use in certain patients. These patients often present with signs and symptoms consistent with an obstruction of the gastrointestinal tract and represent an even greater diagnostic challenge due to the rarity of this complication. These patients also face significant complications from both the bezoar and the medication within the bezoar. To date, treatment of medication bezoars involves mainly physical manipulation of the bezoar through lavage, endoscopic removal, or, in most cases, surgical removal.

Aged↗
PubMed2001

Gastrointestinal bezoars: sonographic and CT characteristics.

OBJECTIVE: The purpose of this study was to assess the value of imaging studies--conventional abdominal radiographs, sonography, and CT--in the diagnosis of gastrointestinal bezoars. METHODS AND METHODS: A review was made of the radiologic findings of 17 consecutive patients with surgically verified gastrointestinal bezoars over a period of 51 months. RESULTS: Twelve patients had a history of previous gastric surgery. In no patient was a bezoar clinically suspected. Phytobezoars were recorded in 16 patients and a trichobezoar in only one. A total of 33 bezoars were identified at surgery. Two patients had isolated gastric bezoars, whereas 15 patients had bezoars located in the small bowel. Among the latter group, associated gastric bezoars were found in eight patients, and five patients had multiple intestinal bezoars. Abdominal radiographs revealed bezoars in three patients, sonography revealed bezoars in 15, and CT revealed bezoars in all 17. Seven patients had associated gastric bezoars revealed at CT versus only two patients with gastric bezoars revealed at sonography. CT revealed multiple intestinal bezoars in five patients whereas sonography revealed them in only two patients. CONCLUSION: Both sonography and CT are reliable methods for diagnosing gastrointestinal bezoars. CT is more accurate, however, and exhibits a quite characteristic bezoar image; in addition, this imaging technique is able to reveal the presence of additional gastrointestinal bezoars.

Adolescent↗
PubMed2003

Cotton Bezoar--a rare cause of intestinal obstruction: case report.

BACKGROUND: Bezoars usually present as a mass in the stomach. The patient often has a preceding history of some psychiatric predisposition. Presentation could be in the form of trichophagy followed by trichobezoar (swallowing of hair leading to formation of bezoar), orphytobezoar (swallowing of vegetable fibres). Rapunzel syndrome is a condition where the parent bezoar is in the stomach and a tail of the fibres or hair extends in to the jejunum. Presentation as intestinal obstruction due to a bezoar in the intestine without a parent bezoar in the stomach is rare, therefore we report it here. CASE REPORT: A 35 year old lady tailor with a previous history of receiving treatment for depression on account of being infertile- years after her marriage, presented to the surgical emergency department with features of acute intestinal obstruction. Exploratory laparotomy and enterotomy revealed a cotton bezoar in the terminal ileum without a parent bezoar in the stomach. She was managed by resection of the affected segment of the ileum and end-to-end anastomosis of the bowel. In the postoperative period the patient gave a history of ingesting cotton threads whenever she was depressed. CONCLUSION: Presence of cotton bezoar is rare and an intestinal bezoar in the absence of parent bezoar in the stomach is still rarer.

Adult↗
PubMed1975

Yeast bezoar formation following gastric surgery.

Yeast bezoar seems to be a relatively common late complication after various gastric operations. The incidence of bezoar depends decisively on the nature of the operation. Vagotomy in particular is conducive to the formation of a bezoar. Vagotomy + Billroth I resection proveded the most propitious conditions for the growth of yeast, for every one-half of the patients in this group developed a bezoar. Yeast bezoars usually appear within a year of the operation. The majority disappear during the first follow-up year, many without any therapy. However, in some cases the bezoar was a rather inconvenient late complication of gastric surgery and one that gave symptoms. It is difficult to draw any definite conclusions concerning the effect of therapy on the disappearance of the bezoar. We used gastric lavage and antimycotics as well as substances that increase gastric acidity. There is still no known method of preventing the formation of yeast bezoars. In the present consensus, a change in the acid conditions and disturbed gastric motility postoperatively are conducive to the formation of a bezoar.

Adult↗
PubMed2000

Bezoars in children: report of four cases.

We reviewed the histories of four children (2 boys and 2 girls, aged 6 mo to 10 yr) with surgically proven bezoars, treated from 1991 to 1998. Two had gastric bezoars and two had intestinal bezoars. All four patients presented with gastrointestinal symptoms and none had undergone previous surgery. Three had a history of abnormal ingestion, including one who ate a pickled fruit from the Boraginaceae (locally known as Po-pu-tsu) plant for 1 year. Plain radiographs revealed intestinal obstruction in all four patients. Abdominal sonography disclosed a hyperechoic band-like lesion and acoustic shadow in both cases of gastric bezoar, and these bezoars were subsequently confirmed by gastric endoscopy. Lower gastrointestinal studies showed obstruction considered most likely to be due to bezoar in one case, while computed tomography (CT) revealed a characteristic small bowel mottled gas pattern in another. Surgical treatment relieved obstruction in all four patients. Bezoar should be suspected in patients with intestinal obstruction who have a history of ingestion of unusual substances. The findings of this report suggest that sonography and endoscopy are useful in the diagnosis of gastric bezoar, while CT is useful in the detection of intestinal bezoar.

Bezoars↗
PubMed1994

Intestinal obstruction and bezoars.

BACKGROUND: Bezoars are large conglomerates of vegetable fibers, hairs, or concretions of various substances located in the stomach or small intestine of humans and certain animals, mainly ruminants. Gastrointestinal bezoars have constituted a relatively common clinical reality ever since the introduction of truncal vagotomy associated with drainage or gastric resection in the treatment of gastroduodenal peptic ulcer. STUDY DESIGN: This study presents a series of 87 cases of intestinal bezoar treated in our department of general surgery. Analysis was made of data obtained retrospectively from clinical histories, together with a clinical and endoscopic review of the patients. RESULTS: Most of the patients had had previous operative treatment (76.3 percent), the most commonly used technique being bilateral truncal vagotomy plus pyloroplasty (75.8 percent). An excessive intake of vegetable fiber was revealed in 39.5 percent of the cases, and alterations in dentition and mastication in 24 percent. Operative treatment was used in all patients. We attempted to fragment the bezoar and milk it to the cecum. Enterotomy and bezoar extraction were reserved for cases where fragmentation was impossible, as enterotomy was associated with more complications (p < 0.05). CONCLUSIONS: Bilateral truncal vagotomy plus pyloroplasty and a excessive ingestion of vegetable fiber are the main factors predisposing to bezoar formation. Clinically, intestinal bezoars manifest themselves in most cases as complete intestinal obstruction. Simple roentgenography of the abdomen is the fundamental technique for diagnosing the occlusive syndrome. Treatment must be operative, during which the bezoar is fragmented and milked to the cecum. The stomach must be explored for associated bezoars.

Adult↗
PubMed1999

Nonoperative treatment of gastric bezoars using electrohydraulic lithotripsy.

BACKGROUND AND STUDY AIMS: Bezoars are collections of indigestible foreign material that are found within the gastrointestinal tract. Nonoperative approaches such as dietary therapy, enzymatic dissolution, and endoscopic removal have been regarded as the mainstays of therapy. The purpose of this paper is to determine the efficacy of electrohydraulic lithotripsy (EHL) as an alternative form of treatment of gastric bezoars. PATIENTS AND METHODS: Between July 1988 and May 1996, 11 patients with large gastric bezoars, defined as those greater than 5 cm in diameter, received endoscopic-guided fragmentation using electrohydraulic lithotripsy. Nine of our patients had a history of ingestion of "Pho Pu Zi", (Cordia dichotoma Frost. f.), one of orange pitch, and one of ingestion of persimmon. RESULTS: The 11 patients in the study underwent EHL for the treatment of their gastric bezoars, with a 100% success rate, which was defined as the lack of residual bezoar seen on post-procedure barium study or endoscopy done 2 days after the procedure. Patients were followed-up clinically for 30-68 months, with seven of the 11 patients undergoing a barium study with no residual bezoar noted. No procedure-related complications were seen, except for pharyngeal pain which was most probably secondary to the placement of the silicon overtube. CONCLUSIONS: Endoscopically guided electrohydraulic lithotripsy is a safe, highly effective, alternative nonsurgical technique for the treatment of gastric bezoars.

Adult↗
PubMed1998

Endoscopic management of huge bezoars.

BACKGROUND AND STUDY AIMS: After the first gastroscopic removal of a bezoar by McKechne in 1972, different endoscopic methods have been reported including a water jet, forceps, snare, and basket. Huge and solid bezoars, however, are still a problem. We report on our experience in fragmenting huge, solid bezoars using a modified needle-knife (bezotome) and a modified mechanical lithotriptor (bezotriptor). PATIENTS AND METHODS: Over a period of 14 months (October 1994 to December 1995), a total of 15 patients (ten male, five female, median age 41 years) with 17 gastric bezoars and one esophageal bezoar, treated endoscopically, were included in the study. A monopolar diathermy knife with a 15 mm needle (bezotome) was used for trichobezoars. For diospyrobezoars we need a bezotriptor. RESULTS: All 18 bezoars, from 4 x 3 x 3 cm to 10 x 8 x 8 cm in size, were successfully fragmented, ten in one session and eight in two sessions. Complete clearance of the upper digestive tract was achieved at the latest three days after the treatment. There were no complications. CONCLUSIONS: Bezotome and bezotriptor are useful endoscopic devices to disintegrate huge, hard bezoars and achieve complete clearance.

Adolescent↗
PubMedDate not supplied

Esophageal bezoar resulting from enteral feedings.

Esophageal bezoars are rare but are known to occur in patients with structural or functional abnormalities of the esophagus. Additionally, sucralfate and casein containing enteral feeding formulas have been implicated in the formation of esophageal bezoars, particularly in the setting of decreased esophageal pH. We present a case in which a patient with functional impairment of the esophagus related to myasthenia gravis developed an esophageal bezoar. Gastroesophageal reflux, altered esophageal pH, and direct instillation of feeding formula through a rent in the feeding tube were additional factors likely leading to bezoar formation in this patient. Endoscopic examination revealed puttylike material consistent with coagulated enteral feeding formula. An esophagram demonstrated a large bezoar filling the middle and distal thirds of the esophagus. The conditions predisposing to bezoar formation and the proposed mechanisms are discussed. We also summarize the reported cases of esophageal bezoars related to enteral feeding formula, sucralfate, or both.

Aged↗
PubMedDate not supplied

[Treatment of the gastric bezoar by endoscopy].

This paper deals with our experiences in a group of patients with gastric bezoars who were treated endoscopically. A group of 7 patients, 5 women and 2 men, from 41 to 62 years of age, with the diagnosis of bezoar was studied. In 6 cases both the clinical and roentgenographic diagnosis was bezoar; in one case the diagnosis was not established before endoscopy. Endoscopic studies were performed to confirm the diagnosis and for treatment. The bezoars were fragmented, under endoscopic observation, with the biopsy mechanism and, after removal of the endoscope, gastric lavage was done through a 12 mm. tube for removal of the bezoar fragments. Postendoscopically all patients were given metoclopramide and new films were take at one week. Confirmation of complete removal of the bezoars was also obtained by subsequent endoscopic control. No complications were observed in any of the patients. We propose that endoscopic removal of bezoars is the treatment of choice because it lowers morbility, mortality and eliminates the need for surgery as well as lowering hospitalization time.

Adult↗
PubMed1997

Bezoar (Capra aegagrus) is a matriarchal candidate for ancestor of domestic goat (Capra hircus): evidence from the mitochondrial DNA diversity.

The leading hypothesis on the ancestor of domestic goats (Capra hircus) is that it is the wild goat called the bezoar or pasang (Capra aegagrus). To verify this hypothesis, we sequenced and compared the cytochrome b gene of mitochondrial DNA from six domestic goats and bezoar. A further sequence for the markhor was taken from the database. In total we detected 51 nucleotide substitutions among the domestic goats, bezoar and markhor. However, only one specific nucleotide substitution was found between the domestic goats and the bezoar. On the other hand, 43 nucleotide substitutions were specific for the markhor. This result suggested a close relationship between the domestic goats and the bezoar. A neighbor-joining and parsimony phylogenetic tree constructed using the sequences showed that the domestic goats and the bezoar belong to the same cluster, while the markhor showed a distinct cluster separate from that of the domestic/bezoar cluster. This result was confirmed by trees based on the sequence of the mitochondrial displacement loop regions. These results suggest that the strongest candidate for a matriarchal ancestor of domestic goats is the bezoar.

Animals↗
PubMed1992

Gastric surgery and bezoars.

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.

Adult↗
PubMed1998

Fungal bezoars as a cause of renal insufficiency in neonates and infants--recommended treatment strategy.

Fungal bezoars may be a cause of urinary tract obstruction and acute renal failure in neonates and young infants. We describe a female very low birth weight infant (25+3 weeks, 795 gram) who developed renal insufficiency on the basis of systemic fungal infection with fungal bezoars in both kidneys. The girl was treated by local irrigation of the kidneys and bladder with amphotericin B via percutaneously inserted bilateral nephrostomy catheters, in combination with intravenous fluconazol. Renal function subsequently improved and after 11 weeks of treatment the bezoars had disappeared sonographically. Follow-up of this child and the one we similarly treated for fungal bezoars before, however, shows suboptimal renal function as assessed by the clearance of creatinine and the mercapto acetyl triglycine scan (MAG III). Until now, insufficient data are available yet to assess with certainly the long-term effects of fungal bezoars on renal function. Based on our experience and a review of the recent literature (1980-1996) on systemic candidal infections in premature infants, we recommend to perform regular renal ultrasound in any case of systemic candidal infection in a prematurely born infant. If candidal bezoars are found with pelvic obstruction, we suggest to start treatment by the insertion of bilateral nephrostomy catheters and local irrigation with amphotericin B in combination with systemic antifungal agents, aiming at both the restoration of renal function and the eradication of the fungal infection.

Candidiasis↗
PubMed1994

Gastrointestinal bezoars.

Of 99 patients with 117 gastrointestinal bezoars, 69 had undergone previous surgery, the most common operation being bilateral truncal vagotomy with pyloroplasty (55 patients). An excessive intake of vegetable fibre was found in 38 patients and poor mastication in 27. Thirty bezoars presented with gastric symptoms and patients had endoscopy as the diagnostic technique; 87 caused symptoms of intestinal obstruction with the diagnosis made by plain abdominal radiography. Medical treatment by enzymic or endoscopic fragmentation was used for 17 of 30 gastric bezoars; surgery was required in the remainder. Intestinal bezoars causing obstruction can be fragmented and 'milked' to the caecum. The stomach should be explored for associated gastric bezoars.

Adolescent↗
PubMed1978

Gastric bezoars. A technique of endoscopic removal.

Gastric bezoar formation is an uncommon sequela of gastroduodenal surgery or unusual eating habits. Because they generally produce severe symptoms, their removal is always necessary. Previously, this required surgical extirpation or slow enzymatic dissolution. We present here an endoscopic procedure for bezoar removal utilized successfully in five patients with vegetable-mucus bezoars. This technique employs a jet spray of water under direct vision to mechanically disrupt the bezoar, which may then be removed using a large gastric lavage tube. This procedure is simple, safe, and rapid and is therefore recommended as an alternative to surgical removal or enzymatic dissolution of gastric bezoars.

Bezoars↗