BACKGROUND Gastric bezoars are indigestible masses that can lead to gastrointestinal ob-struction and ulceration.Standard treatments include endoscopic mechanical lithotripsy with a polypectomy snare and Coca-Cola dis...BACKGROUND Gastric bezoars are indigestible masses that can lead to gastrointestinal ob-struction and ulceration.Standard treatments include endoscopic mechanical lithotripsy with a polypectomy snare and Coca-Cola dissolution therapy or a combination of both approaches.However,giant bezoars frequently require multiple treatment sessions and extended hospital stays.Additionally,snare-based mechanical fragmentation may be limited by factors such as bezoar size,shape,density,slipperiness,and restricted working space.In cases where refra-ctory giant bezoars are unresponsive to traditional methods,surgical intervention is often necessary.CASE SUMMARY A 57-year-old male with a history of type 2 diabetes presented with severe epigastric pain and vomiting.Endoscopy revealed two large phytobezoars and a gastric ulcer.Initial attempts at mechanical fragmentation with a polypectomy snare and Coca-Cola ingestion for dissolution were unsuccessful due to the large size and complex structure of the bezoars.An innovative approach using snare-tip electrocautery was then employed.It successfully penetrated the slippery,hard surface of the bezoars and fragmented them into smaller pieces.The patient was subsequently treated with Coca-Cola ingestion,enzyme supplements,and proton pump inhibitors.He was discharged without complications following the endoscopic sessions.CONCLUSION Snare-tip electrocautery is a safe,cost-effective,and minimally invasive alter-native for managing large,refractory gastric bezoars.This is a valuable option in resource-limited settings.展开更多
BACKGROUND Gastric phytobezoars(GPBs)are very common in northern China.Combined therapy involving carbonated beverage consumption and endoscopic lithotripsy has been shown to be effective and safe.Existing studies on ...BACKGROUND Gastric phytobezoars(GPBs)are very common in northern China.Combined therapy involving carbonated beverage consumption and endoscopic lithotripsy has been shown to be effective and safe.Existing studies on this subject are often case reports highlighting the successful dissolution of phytobezoars through Coca-Cola consumption.Consequently,large-scale prospective investigations in this domain remain scarce.Therefore,we conducted a randomized controlled trial to examine the effects of Coca-Cola consumption on GPBs.AIM To evaluate the impact of Coca-Cola on GPBs,including the dissolution rate,medical expenses,ulcer rate,and operation time.METHODS A total of 160 consecutive patients diagnosed with GPBs were allocated into two groups(a control group and an intervention group)through computer-generated randomization.Patients in the intervention group received a Coca-Cola-based regimen(Coca-Cola 2000-4000 mL per day for 7 d),while those in the control group underwent emergency fragmentation.RESULTS Complete dissolution of GPBs was achieved in 100% of the patients in the intervention group.The disparity in expenses between the control group and intervention group(t=25.791,P=0.000)was statistically significant,and the difference in gastric ulcer occurrence between the control group and intervention group(χ^(2)=6.181,P=0.013)was also statistically significant.CONCLUSION Timely ingestion of Coca-Cola yields significant benefits,including a complete dissolution rate of 100%,a low incidence of gastric ulcers,no need for fragmentation and reduced expenses.展开更多
This manuscript used network pharmacology and experimental verification to analyze the anti-hepatocarcinoma mechanism of action of bezoars in traditional Chinese medicine(TCM),discovering that it can affect the immune...This manuscript used network pharmacology and experimental verification to analyze the anti-hepatocarcinoma mechanism of action of bezoars in traditional Chinese medicine(TCM),discovering that it can affect the immune cells within the tumor microenvironment and related pathways to produce inhibitory effects in liver cancer.In TCM,bezoars have a unique therapeutic advantage in the prevention and treatment of tumors.They play an anti-tumorigenic role by regulating the immune microenvironment through multi-component,multi-target and multi-pathway mechanisms.With the application of nanotechnology,bezoars and their compound preparations have been developed into anti-cancer drugs with unique therapeutic advantages,providing novel treatment options for tumor patients.展开更多
AIM: Bezoars (BZ) are the most common foreign bodies of gastrointestinal tract. Clinical manifestations vary depending on the location of BZ from no symptoms to acute abdominal syndrome. When located in small bowel, t...AIM: Bezoars (BZ) are the most common foreign bodies of gastrointestinal tract. Clinical manifestations vary depending on the location of BZ from no symptoms to acute abdominal syndrome. When located in small bowel, they frequently cause small bowel obstruction (SBO). We aimed to present our experience by reviewing literature.METHODS: Thirty-four patients with gastrointestinal BZ were presented. The data were collected from hospital records and analyzed retrospectively. Morbidity and mortality rates were statistically analyzed between the subgroups according to SBO and endoscopic or surgical treatment modalities.RESULTS: The 34 patients had phytobezoars (PBZ). Two patients with mental retardation and trichotillomania had trichobezoars (TBZ). More than half of them (55.88%) had previous gastric surgery. Also most of them had small bowel bezoars resulting in obstruction. Surgical and endoscopic morbidity rates were 32.14% and 14.28% respectively.The total morbidity rate of this study was 29.41%. Four patients in surgically treated group died. There was no death in endoscopically treated group. The total and surgical mortality rates were 11.76% and 14.28% respectively. The differences in morbidity and mortality rates between the subgroups were not statistically significant.CONCLUSION: BZ are commonly seen in stomach and small intestine. SBO is the most common complication.When uncomplicated, endoscopic or surgical removal can be applied easily.展开更多
The formation of a bezoar is a relatively infrequentdisorder that affects the gastrointestinal system.Bezoars are mainly classified into four types dependingon the material constituting the indigestible mass of thebez...The formation of a bezoar is a relatively infrequentdisorder that affects the gastrointestinal system.Bezoars are mainly classified into four types dependingon the material constituting the indigestible mass of thebezoar phytobezoars, trichobezoars, pharmacobezoars,and lactobezoars. Gastric bezoars often cause ulcerativelesions in the stomach and subsequent bleeding,whereas small intestinal bezoars present with smallbowel obstruction and ileus. A number of articles haveemphasized the usefulness of Coca-Cola？ administrationfor the dissolution of phytobezoars. However, persimmonphytobezoars may be resistant to such dissolutiontreatment because of their harder consistency comparedto other types of phytobezoars. Better understanding ofthe etiology and epidemiology of each type of bezoarwill facilitate prompt diagnosis and management.Here we provide an overview of the prevalence, classification,predisposing factors, and manifestations ofbezoars. Diagnosis and management strategies arealso discussed, reviewing mainly our own case series.Recent progress in basic research regarding persimmonphytobezoars is also briefly reviewed.展开更多
BACKGROUND Bezoars can be found anywhere in the gastrointestinal tract.Esophageal bezoars are rare.Esophageal bezoars are classified as either primary or secondary.It is rarely reported that secondary esophageal bezoa...BACKGROUND Bezoars can be found anywhere in the gastrointestinal tract.Esophageal bezoars are rare.Esophageal bezoars are classified as either primary or secondary.It is rarely reported that secondary esophageal bezoars caused by reverse migration from the stomach lead to acute esophageal obstruction.Guidelines recommend urgent upper endoscopy(within 24 h)for these impactions without complete esophageal obstruction and emergency endoscopy(within 6 h)for those with complete esophageal obstruction.Gastroscopy is regarded as the mainstay for the diagnosis and treatment of esophageal bezoars.CASE SUMMARY A 59-year-old man was hospitalized due to nausea,vomiting and diarrhea for 2 d and sudden retrosternal pain and dysphagia for 10 h.He had a history of type 2 diabetes mellitus for 9 years.Computed tomography revealed dilated lower esophagus,thickening of the esophageal wall,a mass-like lesion with a flocculent high-density shadow and gas bubbles in the esophageal lumen.On gastroscopy,immovable brown bezoars were found in the lower esophagus,which led to esophageal obstruction.Endoscopic fragmentation was successful,and there were no complications.The symptoms of retrosternal pain and dysphagia disappeared after treatment.Mucosal superficial ulcers were observed in the lower esophagus.Multiple biopsy specimens from the lower esophagus revealed nonspecific findings.The patient remained asymptomatic,and follow-up gastroscopy 1 wk after endoscopic fragmentation showed no evidence of bezoars in the esophagus or the stomach.CONCLUSION Acute esophageal obstruction caused by bezoars reversed migration from the stomach is rare.Endoscopic fragmentation is safe,effective and minimally invasive and should be considered as the first-line therapeutic modality.展开更多
Bowel occlusions by bezoars are rare pathologies. They are due to an ob-struction of the intestinal lumen by a solid mass of fruits or undigested vegetable fibers. They are seasonal (wild fruit season from March to Ju...Bowel occlusions by bezoars are rare pathologies. They are due to an ob-struction of the intestinal lumen by a solid mass of fruits or undigested vegetable fibers. They are seasonal (wild fruit season from March to June) in the Sahel Zone. We report a case of small bowel obstruction in a 35-year-old rural man after swallowing a significant amount of wild grapes (Lannea microcarpa). We proceeded to the resection of the occluded ileal segment and performed an ileal terminal ileal anastomosis. There weren’t any complications during the postoperative site.展开更多
BACKGROUND Gastric bezoars are masses of indigestible material that accumulate in the stomach,causing nausea,abdominal pain,and vomiting.Persimmon bezoars(diospyrobezoars),which comprise tannins and fibers from persim...BACKGROUND Gastric bezoars are masses of indigestible material that accumulate in the stomach,causing nausea,abdominal pain,and vomiting.Persimmon bezoars(diospyrobezoars),which comprise tannins and fibers from persimmons,are relatively rare but may cause significant gastric complications,including gastric outlet obstruction or ileus.Although computed tomography(CT)is a useful ima-ging tool,diagnosing bezoars can be challenging because their density is similar to that of food debris and gastric content.CASE SUMMARY Here,we report the case of a 72-year-old woman with a persimmon bezoar that was diagnosed using serial CT imaging and confirmed by endoscopy.CT perfor-med over several months revealed changes in the internal structure and density of the bezoar,suggesting progressive hardening.The patient had a history of a par-tial gastrectomy and excessive persimmon consumption,both of which are risk factors for bezoar formation.Endoscopic fragmentation of the bezoar successfully resolved symptoms.CONCLUSION Gastric bezoars,particularly persimmon bezoars,present diagnostic challenges because of their variable imaging characteristics.Serial CT can document tem-poral changes in bezoar density,potentially reflecting changes in hardness.Early diagnosis and endoscopic treatment are essential for effective management,particularly in patients with predisposing factors.This case underscores the im-portance of considering bezoars in the differential diagnosis of gastric masses,and highlights the value of CT for monitoring changes in bezoar characteristics over time.展开更多
BACKGROUND With less than 90 reported cases to date,stercoral perforation of the colon is a rare occurrence.Stercoral ulceration is thought to occur due to ischemic pressure necrosis of the bowel wall,which is caused ...BACKGROUND With less than 90 reported cases to date,stercoral perforation of the colon is a rare occurrence.Stercoral ulceration is thought to occur due to ischemic pressure necrosis of the bowel wall,which is caused by the presence of a stercoraceous mass.To underscore this urgent surgical situation concerning clinical presentation,surgical treatment,and results,we present the case of a 66-year-old man with a stercoral perforation.CASE SUMMARY A 66-year-old man with a history of hypertension,hyperlipidemia,and gout presented at the emergency department with lower abdominal pain and a low-grade fever lasting for a few hours.Abdominal computed tomography indicated a suspected bezoar(approximately 7.6 cm)in the dilated cecum,accompanied by pericolic fat stranding,mild proximal dilatation of the ileum,pneumoperitoneum,and minimal ascites.Intraoperatively,feculent peritonitis with isolated cecal perforation were observed.Consequently,a right hemicolectomy with peritoneal lavage was performed.A histopathological examination supported the intraoperative findings.CONCLUSION In stercoral perforations,a diagnosis should be diligently pursued,especially in older adults,and prompt surgical intervention should be implemented.展开更多
BACKGROUND Bezoars usually compile human fibers and debris.A special form of bezoar in case of psychologically altered individuals is the trichobezoar.It consists of voluntarily swallowed hair bulks and is normally re...BACKGROUND Bezoars usually compile human fibers and debris.A special form of bezoar in case of psychologically altered individuals is the trichobezoar.It consists of voluntarily swallowed hair bulks and is normally removed via gastroscopy.Trichobezoars leading to ileus have rarely been reported.CASE SUMMARY A 24-year-old female patient presented to the emergency room with abdominal pain,nausea,and vomiting for 3 d.Her previous medical and psychiatric history was unremarkable.Laboratory analysis showed iron deficiency anemia,leukocytosis,and elevated liver enzymes.An abdominal CT scan revealed a dense structure in the patients’stomach which turned out to be a huge trichobezoar completely obstructing the pylorus.The trichobezoar had to be removed surgi-cally.During her postoperative course,a subcutaneous seroma formed.After a single puncture,the rest of the recovery process was unremarkable,and the patient recovered fully.CONCLUSION A mechanical bowel obstruction is a potentially life-threatening event for every patient.In our case a young female was suffering from severe symptoms of an obstruction which might have resulted in serious harm without successful surgical management.展开更多
AIM: To determine the possible predisposing factors of bezoar-induced small bowel obstruction(b I-Sb O) and to discuss the diagnostic value of multi-slice spiral computed tomography,particularly contrast-enhanced scan...AIM: To determine the possible predisposing factors of bezoar-induced small bowel obstruction(b I-Sb O) and to discuss the diagnostic value of multi-slice spiral computed tomography,particularly contrast-enhanced scanning,in this condition.METHODS: A total of 35 b I-Sb O cases treated at our hospital from January 2007 to December 2013 were retrospectively analysed.Complete clinical and computed tomography(CT) data of the patients were available and confirmed by surgery.SbO was clinically diagnosed on the basis of clinical manifestations.Of the 35 patients,18 underwent abdominal and pelvic CT planar scanning with GE 64-slice spiral CT and 17 underwent abdominal and pelvic CT planar scanning with GE 64-slice spiral CT combined with contrastenhanced examination.Original images were processed using a GE ADW4.3 workstation to obtain MPR,CPR,MIP and CTA images.The images of all patients were evaluated by two abdominal imaging experts.The main analytical contents of planar scanning included intestinal bezoar conditions,changes in the intestinal wall and changes in peri-intestinal conditions.Vascular hyperaemia and arterial blood supply conditions at a specific obstruction site and the distal end of the obstruction site were evaluated through contrastenhanced examination.RESULTS: The proportion of males to females among the 35 cases was 1:1.69(13:22); median age was 63.3 years.The following cases were observed: 29(82.8%) cases occurred in autumn and winter and showed a history of consuming high amounts of persimmon and hawthorn; 19(54.3%) cases revealed a history of gastrointestinal surgery; 19 exhibited incomplete dentition,with missing partial or whole posterior teeth; 26 suffered from obstruction at the ileum.A total of 51 bezoars were found in these patients,of whom 16(45.7%) had multiple bezoars.CT planar scanning of bezoars showed lumps with mottled gas inside the intestinal cavity.Furthermore,9 cases of bezoars had envelopes and 11 cases were accompanied with thickening of the distal wall of the obstructed bowel.Scanning of 17 cases was enhanced; the results revealed that the mesenteric blood vessels at the obstruction site and the proximal site were dilated,and a total of 7 cases were accompanied with distal vascular dilation and intestinal wall thickening.CONCLUSION: b I-Sb O exhibits regional and seasonal characteristics.CT planar and contrast-enhanced scanning can be applied to diagnose and observe vascular conditions in obstructed zones.展开更多
Although gastric tumors have overlapping radiologic appearances, some unusual tumors may present specific imaging features. Using multidetector computed tomography(MDCT), with water as a negative oral contrast agent a...Although gastric tumors have overlapping radiologic appearances, some unusual tumors may present specific imaging features. Using multidetector computed tomography(MDCT), with water as a negative oral contrast agent and intravenous contrast medium, can provide critical information for the diagnosis of gastric diseases. In addition, MDCT can evaluate the involvement of the gastric wall and extragastric extent of the disease, as compared with gastroenteroscopy and double-contrast upper gastrointestinal study. Regarding lesion location and size, enhancing and growth patterns, presence of calcification or fat, and involvement of the gastric wall and adjacent structures, CT may provide useful information. In this review article, we review the relevant literature and discuss the CT features and the histopathologic findings of different types of gastric lesions. The lesions are divided into benign(glomus tumors, schwannomas, leiomyomas, and lipomas), malignant(gastrointestinal stromal tumors, mucinous carcinomas, lymphomas, and carcinoid tumors), and tumor-like lesions(ectopic pancreas and bezoar). Familiarity with imaging appearances and pathologic findings can help physicians make an accurate diagnosis.展开更多
Mechanical lithotripsy （ML） is usually considered as a standard treatment option for large bile duct stones. However, it is impossible to retrieve oversized stones because the conventional lithotripsy basket may not...Mechanical lithotripsy （ML） is usually considered as a standard treatment option for large bile duct stones. However, it is impossible to retrieve oversized stones because the conventional lithotripsy basket may not be able to grasp the stone. However, there is no es- tablished endoscopic extraction method for such gi- ant stone removal. We describe a case of successful extraction of a 4-cm large stone using a gastric bezoar basket. A 78-year-old woman had suffered from upper abdominal pain for 20 d. Contrast-enhanced computed tomogram revealed a 4-cm single stone in the distal common bile duct （CBD）. Endoscopic stone retraction was decided upon and endoscopic papillary balloon dilation was performed using a large balloon. An at- tempt to capture the stone using a standard lithotripsy basket failed due to the large stone size. Subsequently, we used a gastric bezoar basket to successfully capturethe stone. The stone was fragmented into small pieces and extracted. The stone was completely removed after two sessions of endoscopic retrograde cholangio- pancreatography; each of which took 30 rain. No com- plications occurred during or after the procedure. The patient was fully recovered and discharged on day 11 of hospitalization. ML using a gastric bezoar basket is a safe and effective retrieval method in select cases, and is considered as an alternative nonoperative option for the management of difficult CBD stones.展开更多
A 9-year-old girl presented with a chief complaint of abdominal pain. Esophagogastroduodenal endoscopy (EGD) identifi ed a long and large gastric trichobezoar extending into the duodenum. We attempted endoscopic retri...A 9-year-old girl presented with a chief complaint of abdominal pain. Esophagogastroduodenal endoscopy (EGD) identifi ed a long and large gastric trichobezoar extending into the duodenum. We attempted endoscopic retrieval after informed consent was obtained from the patient's mother. Initially, a gasper with 5-prolongs, com monly used for retrieval of endoscopically excised poly ps, failed to remove the whole trichobezoar. When a net was used instead, it proved impossible to remove the trichobezoar completely. Therefore, we withdrew the scope from the mouth, leaving the net grasping the tri co bezoar firmly in the stomach. Subsequently, we were able to retrieve about 70% of the trichobezoar manually by grasping the snare part of the net directly. A second pass found no deep laceration or perforation endoscopically. The remaining trichobezoar was completely retrieved with the net. The procedure was completed within 15 min. The retrieved specimens were34 cm in length and 100 g in weight. The patient was discharged uneventfully 5 d thereafter. She was advised to visit a psychiatrist to avoid suffering from a relapse. Follow-up EGD showed no trichobezoar, and the patient' s frontal hair grew back.展开更多
This paper describes a rare complication of enteral feeding,esophageal obstruction due to feeding formula bezoar,and reviews the published cases. An attempt to re-insert the nasogastric tube in a chronically ventilate...This paper describes a rare complication of enteral feeding,esophageal obstruction due to feeding formula bezoar,and reviews the published cases. An attempt to re-insert the nasogastric tube in a chronically ventilated 80-year-old female fed via a nasogastric tube with Jevity failed. An esophagogastroduodenoscopy revealed an 18 cm-long concretion of the feeding formula,fi-lling most of the esophageal lumen,which was removed endo scopically. Forty-two cases of feeding formula esophageal bezoars have been reported in the literature. The formation of feeding formula bezoars is triggered by acidic gastroesophageal reflux. The acidic pH in the esophagus causes clotting of the casein in the formula. Predisposing factors for bezoar formation are:mechanical ventilation,supine position,neurological diseases,diabetes mellitus,hypothyroidism,obesity and history of partial gastrectomy. Diagnosis and removal of the bezoar is done endoscopically. Feeding in a semi-recumbent position,administration of prokinetic agents and proton pump inhibitors may prevent this complication.展开更多
Objective:To investigate the relation between fruit seeds,plants residuals and appendicitis. Methods:Among cases that underwent appendectomy,the appendicitis cases having fruit seeds and undigested plant residuals in ...Objective:To investigate the relation between fruit seeds,plants residuals and appendicitis. Methods:Among cases that underwent appendectomy,the appendicitis cases having fruit seeds and undigested plant residuals in their etiology were examined retrospectively.Also, histopathological features,age,sex,and parameters of morbidity and mortality were used. Results:Fruit seed was found in one case(0.05%) with presence of pus in appendix lumen, undigested plant residuals in 7 cases(0.35%).It was determined that there were appendix inflammation in 2 of the plant residuals cases,while there were obstruction and lymphoid hyperplasia in the appendix lumen of 5 cases.No mortality was observed.Conclusions:The ratio of acute appendicitis caused by plants is minimal among all appendectomised patients, but avoidence of eating undigested fruit seeds and chewing plants well may help to prevent appendicitis.展开更多
BACKGROUND Bezoars are conglomerates of indigestible foreign material that can be found in the gastrointestinal tract.Gastric ulcer,gastrointestinal perforation,and intestinal obstruction are the main complications.Ac...BACKGROUND Bezoars are conglomerates of indigestible foreign material that can be found in the gastrointestinal tract.Gastric ulcer,gastrointestinal perforation,and intestinal obstruction are the main complications.Acute pancreatitis secondary to bezoar is rare.Here,we present a rare case of a migratory gastric bezoar complicated by acute pancreatitis and small bowel obstruction after dissolution therapy.CASE SUMMARY A-65-year-old woman underwent gastroscopy because of epigastric pain,which revealed a huge bezoar and a gastric ulcer 10 d prior.The patient was discharged with a prescription of drinking 1 L Coca-Cola daily for 6 d,without repeat gastroscopy.However,she suddenly developed epigastric pain,nausea and vomiting for 3 d.Abdominal computed tomography(CT)revealed mild inflammation of the pancreas.Magnetic resonance cholangiopancreatography showed no abnormalities in the pancreatic duct or common bile duct.The nasogastric tube still showed drainage of more than 1.6 L of dark fluid each day after symptomatic treatment.Abdominal CT re-examination suggested intestinal obstruction.Esophagogastroduodenoscopy revealed a huge yellowish hard mass in the jejunal lumen,and we used the basket and net to fragment the bezoar.She was discharged with a good outcome.CONCLUSION Endoscopic therapy is the first choice for gastric bezoars.When mechanical disintegration cannot be achieved,timing of repeat endoscopy is important during Coca-Cola dissolution therapy.展开更多
Foreign bodies and bezoars are commonly encountered in children. We describe a child aged 11 years who ingested large amounts of plastic material used for knitting chairs and charpoys. The conglomerate of plastic thre...Foreign bodies and bezoars are commonly encountered in children. We describe a child aged 11 years who ingested large amounts of plastic material used for knitting chairs and charpoys. The conglomerate of plastic threads, entrapped food material and other debris, formed a huge mass occupying the whole stomach. Chronic irritation of the gastric antral mucosa led to ulceration and formation of hyperplastic polyps. We labeled this new entity as a “plastobezoar”. The entire bezoar could be removed endoscopically.展开更多
Bezoars are masses or concretions of indigestible materials found in the gastrointestinal tract,usually in the stomach.Case reports of childhood gastric bezoars(particularly phytobezoars)are rare.In this age group the...Bezoars are masses or concretions of indigestible materials found in the gastrointestinal tract,usually in the stomach.Case reports of childhood gastric bezoars(particularly phytobezoars)are rare.In this age group they represent a therapeutic challenge,because of the combination of hard consistency and great size.The present report concerns an 8-year-old boy with a history of high fruit intake,presenting with abdominal complaints due to a large gastric phytobezoar.Successful endoscopic fragmentation coupled with suction removal was accomplished,using a standard-channel endoscope.Although laborious,it has been shown to be an efficacious and safe procedure,completed in one session.Endoscopic techniques for pediatric bezoar management may thus be cost effective,taking into account the avoidance ofsurgery,the length of the hospital stay and the number of endoscopic sessions.展开更多
文摘BACKGROUND Gastric bezoars are indigestible masses that can lead to gastrointestinal ob-struction and ulceration.Standard treatments include endoscopic mechanical lithotripsy with a polypectomy snare and Coca-Cola dissolution therapy or a combination of both approaches.However,giant bezoars frequently require multiple treatment sessions and extended hospital stays.Additionally,snare-based mechanical fragmentation may be limited by factors such as bezoar size,shape,density,slipperiness,and restricted working space.In cases where refra-ctory giant bezoars are unresponsive to traditional methods,surgical intervention is often necessary.CASE SUMMARY A 57-year-old male with a history of type 2 diabetes presented with severe epigastric pain and vomiting.Endoscopy revealed two large phytobezoars and a gastric ulcer.Initial attempts at mechanical fragmentation with a polypectomy snare and Coca-Cola ingestion for dissolution were unsuccessful due to the large size and complex structure of the bezoars.An innovative approach using snare-tip electrocautery was then employed.It successfully penetrated the slippery,hard surface of the bezoars and fragmented them into smaller pieces.The patient was subsequently treated with Coca-Cola ingestion,enzyme supplements,and proton pump inhibitors.He was discharged without complications following the endoscopic sessions.CONCLUSION Snare-tip electrocautery is a safe,cost-effective,and minimally invasive alter-native for managing large,refractory gastric bezoars.This is a valuable option in resource-limited settings.
文摘BACKGROUND Gastric phytobezoars(GPBs)are very common in northern China.Combined therapy involving carbonated beverage consumption and endoscopic lithotripsy has been shown to be effective and safe.Existing studies on this subject are often case reports highlighting the successful dissolution of phytobezoars through Coca-Cola consumption.Consequently,large-scale prospective investigations in this domain remain scarce.Therefore,we conducted a randomized controlled trial to examine the effects of Coca-Cola consumption on GPBs.AIM To evaluate the impact of Coca-Cola on GPBs,including the dissolution rate,medical expenses,ulcer rate,and operation time.METHODS A total of 160 consecutive patients diagnosed with GPBs were allocated into two groups(a control group and an intervention group)through computer-generated randomization.Patients in the intervention group received a Coca-Cola-based regimen(Coca-Cola 2000-4000 mL per day for 7 d),while those in the control group underwent emergency fragmentation.RESULTS Complete dissolution of GPBs was achieved in 100% of the patients in the intervention group.The disparity in expenses between the control group and intervention group(t=25.791,P=0.000)was statistically significant,and the difference in gastric ulcer occurrence between the control group and intervention group(χ^(2)=6.181,P=0.013)was also statistically significant.CONCLUSION Timely ingestion of Coca-Cola yields significant benefits,including a complete dissolution rate of 100%,a low incidence of gastric ulcers,no need for fragmentation and reduced expenses.
基金Supported by 2023 Government-funded Project of The Outstanding Talents Training Program in Clinical Medicine,No.ZF2023165Key Research and Development Projects of Hebei Province,No.18277731Dand Natural Science Foundation of Hebei Province,No.H202423105.
文摘This manuscript used network pharmacology and experimental verification to analyze the anti-hepatocarcinoma mechanism of action of bezoars in traditional Chinese medicine(TCM),discovering that it can affect the immune cells within the tumor microenvironment and related pathways to produce inhibitory effects in liver cancer.In TCM,bezoars have a unique therapeutic advantage in the prevention and treatment of tumors.They play an anti-tumorigenic role by regulating the immune microenvironment through multi-component,multi-target and multi-pathway mechanisms.With the application of nanotechnology,bezoars and their compound preparations have been developed into anti-cancer drugs with unique therapeutic advantages,providing novel treatment options for tumor patients.
文摘AIM: Bezoars (BZ) are the most common foreign bodies of gastrointestinal tract. Clinical manifestations vary depending on the location of BZ from no symptoms to acute abdominal syndrome. When located in small bowel, they frequently cause small bowel obstruction (SBO). We aimed to present our experience by reviewing literature.METHODS: Thirty-four patients with gastrointestinal BZ were presented. The data were collected from hospital records and analyzed retrospectively. Morbidity and mortality rates were statistically analyzed between the subgroups according to SBO and endoscopic or surgical treatment modalities.RESULTS: The 34 patients had phytobezoars (PBZ). Two patients with mental retardation and trichotillomania had trichobezoars (TBZ). More than half of them (55.88%) had previous gastric surgery. Also most of them had small bowel bezoars resulting in obstruction. Surgical and endoscopic morbidity rates were 32.14% and 14.28% respectively.The total morbidity rate of this study was 29.41%. Four patients in surgically treated group died. There was no death in endoscopically treated group. The total and surgical mortality rates were 11.76% and 14.28% respectively. The differences in morbidity and mortality rates between the subgroups were not statistically significant.CONCLUSION: BZ are commonly seen in stomach and small intestine. SBO is the most common complication.When uncomplicated, endoscopic or surgical removal can be applied easily.
文摘The formation of a bezoar is a relatively infrequentdisorder that affects the gastrointestinal system.Bezoars are mainly classified into four types dependingon the material constituting the indigestible mass of thebezoar phytobezoars, trichobezoars, pharmacobezoars,and lactobezoars. Gastric bezoars often cause ulcerativelesions in the stomach and subsequent bleeding,whereas small intestinal bezoars present with smallbowel obstruction and ileus. A number of articles haveemphasized the usefulness of Coca-Cola？ administrationfor the dissolution of phytobezoars. However, persimmonphytobezoars may be resistant to such dissolutiontreatment because of their harder consistency comparedto other types of phytobezoars. Better understanding ofthe etiology and epidemiology of each type of bezoarwill facilitate prompt diagnosis and management.Here we provide an overview of the prevalence, classification,predisposing factors, and manifestations ofbezoars. Diagnosis and management strategies arealso discussed, reviewing mainly our own case series.Recent progress in basic research regarding persimmonphytobezoars is also briefly reviewed.
文摘BACKGROUND Bezoars can be found anywhere in the gastrointestinal tract.Esophageal bezoars are rare.Esophageal bezoars are classified as either primary or secondary.It is rarely reported that secondary esophageal bezoars caused by reverse migration from the stomach lead to acute esophageal obstruction.Guidelines recommend urgent upper endoscopy(within 24 h)for these impactions without complete esophageal obstruction and emergency endoscopy(within 6 h)for those with complete esophageal obstruction.Gastroscopy is regarded as the mainstay for the diagnosis and treatment of esophageal bezoars.CASE SUMMARY A 59-year-old man was hospitalized due to nausea,vomiting and diarrhea for 2 d and sudden retrosternal pain and dysphagia for 10 h.He had a history of type 2 diabetes mellitus for 9 years.Computed tomography revealed dilated lower esophagus,thickening of the esophageal wall,a mass-like lesion with a flocculent high-density shadow and gas bubbles in the esophageal lumen.On gastroscopy,immovable brown bezoars were found in the lower esophagus,which led to esophageal obstruction.Endoscopic fragmentation was successful,and there were no complications.The symptoms of retrosternal pain and dysphagia disappeared after treatment.Mucosal superficial ulcers were observed in the lower esophagus.Multiple biopsy specimens from the lower esophagus revealed nonspecific findings.The patient remained asymptomatic,and follow-up gastroscopy 1 wk after endoscopic fragmentation showed no evidence of bezoars in the esophagus or the stomach.CONCLUSION Acute esophageal obstruction caused by bezoars reversed migration from the stomach is rare.Endoscopic fragmentation is safe,effective and minimally invasive and should be considered as the first-line therapeutic modality.
文摘Bowel occlusions by bezoars are rare pathologies. They are due to an ob-struction of the intestinal lumen by a solid mass of fruits or undigested vegetable fibers. They are seasonal (wild fruit season from March to June) in the Sahel Zone. We report a case of small bowel obstruction in a 35-year-old rural man after swallowing a significant amount of wild grapes (Lannea microcarpa). We proceeded to the resection of the occluded ileal segment and performed an ileal terminal ileal anastomosis. There weren’t any complications during the postoperative site.
文摘BACKGROUND Gastric bezoars are masses of indigestible material that accumulate in the stomach,causing nausea,abdominal pain,and vomiting.Persimmon bezoars(diospyrobezoars),which comprise tannins and fibers from persimmons,are relatively rare but may cause significant gastric complications,including gastric outlet obstruction or ileus.Although computed tomography(CT)is a useful ima-ging tool,diagnosing bezoars can be challenging because their density is similar to that of food debris and gastric content.CASE SUMMARY Here,we report the case of a 72-year-old woman with a persimmon bezoar that was diagnosed using serial CT imaging and confirmed by endoscopy.CT perfor-med over several months revealed changes in the internal structure and density of the bezoar,suggesting progressive hardening.The patient had a history of a par-tial gastrectomy and excessive persimmon consumption,both of which are risk factors for bezoar formation.Endoscopic fragmentation of the bezoar successfully resolved symptoms.CONCLUSION Gastric bezoars,particularly persimmon bezoars,present diagnostic challenges because of their variable imaging characteristics.Serial CT can document tem-poral changes in bezoar density,potentially reflecting changes in hardness.Early diagnosis and endoscopic treatment are essential for effective management,particularly in patients with predisposing factors.This case underscores the im-portance of considering bezoars in the differential diagnosis of gastric masses,and highlights the value of CT for monitoring changes in bezoar characteristics over time.
文摘BACKGROUND With less than 90 reported cases to date,stercoral perforation of the colon is a rare occurrence.Stercoral ulceration is thought to occur due to ischemic pressure necrosis of the bowel wall,which is caused by the presence of a stercoraceous mass.To underscore this urgent surgical situation concerning clinical presentation,surgical treatment,and results,we present the case of a 66-year-old man with a stercoral perforation.CASE SUMMARY A 66-year-old man with a history of hypertension,hyperlipidemia,and gout presented at the emergency department with lower abdominal pain and a low-grade fever lasting for a few hours.Abdominal computed tomography indicated a suspected bezoar(approximately 7.6 cm)in the dilated cecum,accompanied by pericolic fat stranding,mild proximal dilatation of the ileum,pneumoperitoneum,and minimal ascites.Intraoperatively,feculent peritonitis with isolated cecal perforation were observed.Consequently,a right hemicolectomy with peritoneal lavage was performed.A histopathological examination supported the intraoperative findings.CONCLUSION In stercoral perforations,a diagnosis should be diligently pursued,especially in older adults,and prompt surgical intervention should be implemented.
文摘BACKGROUND Bezoars usually compile human fibers and debris.A special form of bezoar in case of psychologically altered individuals is the trichobezoar.It consists of voluntarily swallowed hair bulks and is normally removed via gastroscopy.Trichobezoars leading to ileus have rarely been reported.CASE SUMMARY A 24-year-old female patient presented to the emergency room with abdominal pain,nausea,and vomiting for 3 d.Her previous medical and psychiatric history was unremarkable.Laboratory analysis showed iron deficiency anemia,leukocytosis,and elevated liver enzymes.An abdominal CT scan revealed a dense structure in the patients’stomach which turned out to be a huge trichobezoar completely obstructing the pylorus.The trichobezoar had to be removed surgi-cally.During her postoperative course,a subcutaneous seroma formed.After a single puncture,the rest of the recovery process was unremarkable,and the patient recovered fully.CONCLUSION A mechanical bowel obstruction is a potentially life-threatening event for every patient.In our case a young female was suffering from severe symptoms of an obstruction which might have resulted in serious harm without successful surgical management.
文摘AIM: To determine the possible predisposing factors of bezoar-induced small bowel obstruction(b I-Sb O) and to discuss the diagnostic value of multi-slice spiral computed tomography,particularly contrast-enhanced scanning,in this condition.METHODS: A total of 35 b I-Sb O cases treated at our hospital from January 2007 to December 2013 were retrospectively analysed.Complete clinical and computed tomography(CT) data of the patients were available and confirmed by surgery.SbO was clinically diagnosed on the basis of clinical manifestations.Of the 35 patients,18 underwent abdominal and pelvic CT planar scanning with GE 64-slice spiral CT and 17 underwent abdominal and pelvic CT planar scanning with GE 64-slice spiral CT combined with contrastenhanced examination.Original images were processed using a GE ADW4.3 workstation to obtain MPR,CPR,MIP and CTA images.The images of all patients were evaluated by two abdominal imaging experts.The main analytical contents of planar scanning included intestinal bezoar conditions,changes in the intestinal wall and changes in peri-intestinal conditions.Vascular hyperaemia and arterial blood supply conditions at a specific obstruction site and the distal end of the obstruction site were evaluated through contrastenhanced examination.RESULTS: The proportion of males to females among the 35 cases was 1:1.69(13:22); median age was 63.3 years.The following cases were observed: 29(82.8%) cases occurred in autumn and winter and showed a history of consuming high amounts of persimmon and hawthorn; 19(54.3%) cases revealed a history of gastrointestinal surgery; 19 exhibited incomplete dentition,with missing partial or whole posterior teeth; 26 suffered from obstruction at the ileum.A total of 51 bezoars were found in these patients,of whom 16(45.7%) had multiple bezoars.CT planar scanning of bezoars showed lumps with mottled gas inside the intestinal cavity.Furthermore,9 cases of bezoars had envelopes and 11 cases were accompanied with thickening of the distal wall of the obstructed bowel.Scanning of 17 cases was enhanced; the results revealed that the mesenteric blood vessels at the obstruction site and the proximal site were dilated,and a total of 7 cases were accompanied with distal vascular dilation and intestinal wall thickening.CONCLUSION: b I-Sb O exhibits regional and seasonal characteristics.CT planar and contrast-enhanced scanning can be applied to diagnose and observe vascular conditions in obstructed zones.
文摘Although gastric tumors have overlapping radiologic appearances, some unusual tumors may present specific imaging features. Using multidetector computed tomography(MDCT), with water as a negative oral contrast agent and intravenous contrast medium, can provide critical information for the diagnosis of gastric diseases. In addition, MDCT can evaluate the involvement of the gastric wall and extragastric extent of the disease, as compared with gastroenteroscopy and double-contrast upper gastrointestinal study. Regarding lesion location and size, enhancing and growth patterns, presence of calcification or fat, and involvement of the gastric wall and adjacent structures, CT may provide useful information. In this review article, we review the relevant literature and discuss the CT features and the histopathologic findings of different types of gastric lesions. The lesions are divided into benign(glomus tumors, schwannomas, leiomyomas, and lipomas), malignant(gastrointestinal stromal tumors, mucinous carcinomas, lymphomas, and carcinoid tumors), and tumor-like lesions(ectopic pancreas and bezoar). Familiarity with imaging appearances and pathologic findings can help physicians make an accurate diagnosis.
基金Supported by Grant from Inha University Research
文摘Mechanical lithotripsy （ML） is usually considered as a standard treatment option for large bile duct stones. However, it is impossible to retrieve oversized stones because the conventional lithotripsy basket may not be able to grasp the stone. However, there is no es- tablished endoscopic extraction method for such gi- ant stone removal. We describe a case of successful extraction of a 4-cm large stone using a gastric bezoar basket. A 78-year-old woman had suffered from upper abdominal pain for 20 d. Contrast-enhanced computed tomogram revealed a 4-cm single stone in the distal common bile duct （CBD）. Endoscopic stone retraction was decided upon and endoscopic papillary balloon dilation was performed using a large balloon. An at- tempt to capture the stone using a standard lithotripsy basket failed due to the large stone size. Subsequently, we used a gastric bezoar basket to successfully capturethe stone. The stone was fragmented into small pieces and extracted. The stone was completely removed after two sessions of endoscopic retrograde cholangio- pancreatography; each of which took 30 rain. No com- plications occurred during or after the procedure. The patient was fully recovered and discharged on day 11 of hospitalization. ML using a gastric bezoar basket is a safe and effective retrieval method in select cases, and is considered as an alternative nonoperative option for the management of difficult CBD stones.
文摘A 9-year-old girl presented with a chief complaint of abdominal pain. Esophagogastroduodenal endoscopy (EGD) identifi ed a long and large gastric trichobezoar extending into the duodenum. We attempted endoscopic retrieval after informed consent was obtained from the patient's mother. Initially, a gasper with 5-prolongs, com monly used for retrieval of endoscopically excised poly ps, failed to remove the whole trichobezoar. When a net was used instead, it proved impossible to remove the trichobezoar completely. Therefore, we withdrew the scope from the mouth, leaving the net grasping the tri co bezoar firmly in the stomach. Subsequently, we were able to retrieve about 70% of the trichobezoar manually by grasping the snare part of the net directly. A second pass found no deep laceration or perforation endoscopically. The remaining trichobezoar was completely retrieved with the net. The procedure was completed within 15 min. The retrieved specimens were34 cm in length and 100 g in weight. The patient was discharged uneventfully 5 d thereafter. She was advised to visit a psychiatrist to avoid suffering from a relapse. Follow-up EGD showed no trichobezoar, and the patient' s frontal hair grew back.
文摘This paper describes a rare complication of enteral feeding,esophageal obstruction due to feeding formula bezoar,and reviews the published cases. An attempt to re-insert the nasogastric tube in a chronically ventilated 80-year-old female fed via a nasogastric tube with Jevity failed. An esophagogastroduodenoscopy revealed an 18 cm-long concretion of the feeding formula,fi-lling most of the esophageal lumen,which was removed endo scopically. Forty-two cases of feeding formula esophageal bezoars have been reported in the literature. The formation of feeding formula bezoars is triggered by acidic gastroesophageal reflux. The acidic pH in the esophagus causes clotting of the casein in the formula. Predisposing factors for bezoar formation are:mechanical ventilation,supine position,neurological diseases,diabetes mellitus,hypothyroidism,obesity and history of partial gastrectomy. Diagnosis and removal of the bezoar is done endoscopically. Feeding in a semi-recumbent position,administration of prokinetic agents and proton pump inhibitors may prevent this complication.
文摘Objective:To investigate the relation between fruit seeds,plants residuals and appendicitis. Methods:Among cases that underwent appendectomy,the appendicitis cases having fruit seeds and undigested plant residuals in their etiology were examined retrospectively.Also, histopathological features,age,sex,and parameters of morbidity and mortality were used. Results:Fruit seed was found in one case(0.05%) with presence of pus in appendix lumen, undigested plant residuals in 7 cases(0.35%).It was determined that there were appendix inflammation in 2 of the plant residuals cases,while there were obstruction and lymphoid hyperplasia in the appendix lumen of 5 cases.No mortality was observed.Conclusions:The ratio of acute appendicitis caused by plants is minimal among all appendectomised patients, but avoidence of eating undigested fruit seeds and chewing plants well may help to prevent appendicitis.
文摘BACKGROUND Bezoars are conglomerates of indigestible foreign material that can be found in the gastrointestinal tract.Gastric ulcer,gastrointestinal perforation,and intestinal obstruction are the main complications.Acute pancreatitis secondary to bezoar is rare.Here,we present a rare case of a migratory gastric bezoar complicated by acute pancreatitis and small bowel obstruction after dissolution therapy.CASE SUMMARY A-65-year-old woman underwent gastroscopy because of epigastric pain,which revealed a huge bezoar and a gastric ulcer 10 d prior.The patient was discharged with a prescription of drinking 1 L Coca-Cola daily for 6 d,without repeat gastroscopy.However,she suddenly developed epigastric pain,nausea and vomiting for 3 d.Abdominal computed tomography(CT)revealed mild inflammation of the pancreas.Magnetic resonance cholangiopancreatography showed no abnormalities in the pancreatic duct or common bile duct.The nasogastric tube still showed drainage of more than 1.6 L of dark fluid each day after symptomatic treatment.Abdominal CT re-examination suggested intestinal obstruction.Esophagogastroduodenoscopy revealed a huge yellowish hard mass in the jejunal lumen,and we used the basket and net to fragment the bezoar.She was discharged with a good outcome.CONCLUSION Endoscopic therapy is the first choice for gastric bezoars.When mechanical disintegration cannot be achieved,timing of repeat endoscopy is important during Coca-Cola dissolution therapy.
文摘Foreign bodies and bezoars are commonly encountered in children. We describe a child aged 11 years who ingested large amounts of plastic material used for knitting chairs and charpoys. The conglomerate of plastic threads, entrapped food material and other debris, formed a huge mass occupying the whole stomach. Chronic irritation of the gastric antral mucosa led to ulceration and formation of hyperplastic polyps. We labeled this new entity as a “plastobezoar”. The entire bezoar could be removed endoscopically.
文摘Bezoars are masses or concretions of indigestible materials found in the gastrointestinal tract,usually in the stomach.Case reports of childhood gastric bezoars(particularly phytobezoars)are rare.In this age group they represent a therapeutic challenge,because of the combination of hard consistency and great size.The present report concerns an 8-year-old boy with a history of high fruit intake,presenting with abdominal complaints due to a large gastric phytobezoar.Successful endoscopic fragmentation coupled with suction removal was accomplished,using a standard-channel endoscope.Although laborious,it has been shown to be an efficacious and safe procedure,completed in one session.Endoscopic techniques for pediatric bezoar management may thus be cost effective,taking into account the avoidance ofsurgery,the length of the hospital stay and the number of endoscopic sessions.
