GASTRIC BEZOAR
be·zoar Pronunciation: 'bE-"zOr, -"zor Function: noun Etymology: Middle French, from Medieval Latin, from Arabic dialect bezuwAr, from Arabic bAzahr, from Persian pAd-zahr, from pAd protecting (against) + zahr poison any of various calculi found chiefly in the gastrointestinal organs and formerly believed to possess magical properties -- called also bezoar stone • • Incidence: Females 10-19 years old Presentation: o Complaints: abdominal pain early satiety nausea (postprandial) vomiting weight loss poor appetite halitosis belching +/- foul odor diarrhea ulcers o Past Medical History diabetic gastroparesis gastric surgery- antrectomy / vagotomy psychiatric problems occupational exposure mental retardation Possible palpable, mobile mass in the abdomen Can appreciate mass on plain film, barium study, US, CT scan. Endoscopy is best. Treatments: o Small bezoar: Endoscopic removal chemical treatment cellulose coca-cola meat tenderizer o Large bezoar: Surgery Open vs Laparascopic Gastrotomy Complications: o Small bowel obstruction o esophageal bezoar → achalacia o bleeding o perforation o steatorrhea
• • •
•
34
• •
o malabsorption o intussusception o Starting OR fire! Prognosis: very good Prevention: cut hair short, optimize environment, psychiatric follow up
35
References: • • • • Ariel S. Frey, B.A., M.A.T, et al. Hair Apparent: Rapunzel Syndrome. Am J Psychiatry 162:2, February 2005 De Backer A; Van Nooten V; Vandenplas Y. Huge Gastric Trichobezoar in a 10-YearOld Girl: Case Report With Emphasis on Endoscopy in Diagnosis and Therapy. Journal of Pediatric Gastroenterology and Nutrition. Volume 28(5),May 1999 pp. 513-515 Yao, Chung-Chin MD et al, Laparosopic Removal of Large Gastric Phytobezoars. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 10(4):243-245, August 2000. Kushaljit Singh Sodhi, et al.Gastric Bezoar: An Uncommon Yet Important Cause Of Abdominal Pain. The Journal of Emergency Medicine, Vol. 28, No. 4, pp. 467–468, 2005
Kelly Stets, M.D. June 9, 2005
36