A 53-year-old mentally retarded male was brought to our emergency room after vomiting a plastic glove. Computed tomography revealed marked gastric distention containing large amount of residual food debris. Endoscopic retrieval was unsuccessful. Surgical removal of the foreign bodies was done. The patient did well and was discharged from the hospital.
Gastric bezoars are foreign bodies in the stomach that increase in size due to accumulation of nonabsorbable food or fibers . It is defined as “any of various calculi found chiefly in the gastrointestinal organs and formerly believed to possess magical properties from Arabic bāzahr” . The clinical picture ranges from abdominal pain, nausea, vomiting, early satiety and weight loss, to bleeding ulcer, intestinal obstruction and perforation .
A 53-year-old mentally retarded male was brought to our emergency room after vomiting a plastic glove. The patient had two weeks history of intermittent nausea and vomiting. Computed tomography of the abdomen showed a non-enhancing mixed density intraluminal gastric mass (Figure 1).
An endoscopy done to confirm the diagnosis and retrieve the foreign bodies was not successful. The patient was taken to the operating room and an upper midline incision was done (multiple previous abdominal surgeries). Gastrotomy and foreign body bezoars removal was performed (Figure 2).
The patient did well and was discharged from the hospital.
More than 90% of bezoars cases are found in children and young female with pica, psychiatric disorders, or mental retardation , but rarely a severe psychiatric disorder is seen . The clinical picture ranges from abdominal pain, nausea, vomiting, early satiety and weight loss, to bleeding ulcer, intestinal obstruction and perforation. Anemia and hypoalbuminemia associated with chronic gastritis usually go unnoticed until the case is brought to light by the onset of more severe complications such as hemorrhage, enteric or pancreatic or biliary obstruction . Diagnostic modalities include abdominal ultrasound (US), computed tomography (CT) scan and upper endoscopy. CT scan has a higher accuracy rate than US . Treatment of bezoars includes observation, dissolution, fragmentation, laparotomy or laparoscopic gastrotomy for removal. Gastroscopic fragmentation, nasogastric lavage or suction, and enzymatic therapy with cellulose and papain have been tried . In our case, the use of endoscopy was not successful and surgical retrieval was the best option.
Bezoars are a potentially serious problem. Treatment includes gastric lavage, dissolution, endoscopic retrieval and surgery. It is prudent to prevent future occurrences via dietary counseling, avoidance of certain medications, and correction of underlying motility disorders if present. After successful management, psychiatric evaluation should be considered and the patient and/or his care giver should be educated to prevent recurrence.
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Surgical Removal of Numerous Foreign Body Gastric Bezoar: A Case Report
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Cite this article as:
Ahmed M, Habis S, Mahmoud A, et al. (March 04, 2019) Surgical Removal of Numerous Foreign Body Gastric Bezoar: A Case Report. Cureus 11(3): e4173. doi:10.7759/cureus.4173
Received by Cureus: February 08, 2019
Peer review began: February 12, 2019
Peer review concluded: February 23, 2019
Published: March 04, 2019
© Copyright 2019
Ahmed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.