Stomach: Foreign Body

Bezoars

Basics

  • Definition: A Foreign Body of Indigestible Material
  • Most Common in the Stomach
  • Risk Factors:
    • History of Gastric Surgery (70-94%) or Vagotomy (54-80%)
    • Delayed Gastric Emptying & Gastric Dysmotility
    • Gastric Outlet Obstruction
    • Dehydration

Types

  • Trichobezoars (Swallowed Hair)
    • Most Common in Young Adult Women
      • Demonstrates Alopecia
    • Associated with Psychiatric Disorders
    • Rapunzel Syndrome – Long Tail of Trichobezoar Extends into the Small Bowel & Cecum
  • Phytobezoars (Fiber/Vegetable Matter)
    • Higher Risk with Diabetes
  • Pharmacobezoars (Medications)
    • Drug Overdose is a Rare Complication

Presentation

  • Sx: Pain, Nausea, Vomiting & Anorexia
  • Complications:
    • Pressure Necrosis/Ulceration
    • Gastric Outlet or Bowel Obstruction
    • Obstructive Jaundice
    • Pancreatitis

Diagnosis

  • Dx: EGD

Treatment

  • Trichobezoars: Surgical Gastrostomy & Removal
    • EGD Has Poor Success & May Cause Complications
    • Include Psychiatry Referral
  • Phytobezoars: Enzymatic Dissolution & Endoscopic Fragmentation/Removal
    • Enzymatic Agents: Coca-Cola, Cellulase or Papain
    • Partial Dissolution Can Cause Obstruction
    • Metoclopramide Often Used Concurrently
    • Surgical Removal if Fails
  • Pharmacobezoars: Varies Based on Pharmaceutical Agent
    • Options: Gastric Lavage, Enzymatic Dissolution, Endoscopic or Surgical Removal

Trichobezoar

Rapunzel Syndrome 1

Phytobezoar 2

Pharmacobezoar 3

Other Foreign Body

Other Foreign Body

References

  1. Emre AU, Tascilar O, Karadeniz G, Irkorucu O, Karakaya K, Comert M. Rapunzel syndrome of a cotton bezoar in a multimorbid patient. Clinics (Sao Paulo). 2008 Apr;63(2):285-8. (License: CC BY-4.0)
  2. Occhionorelli S, Zese M, Targa S, Cappellari L, Stano R, Vasquez G. A rare case of a double phytobezoar causing gastric and jejunum obstruction in an adult man: a case report. J Med Case Rep. 2016 Dec 15;10(1):350. (License: CC BY-4.0)
  3. Sultania S, Singh Dhandhu B, Bhardwaj H, Nijhawan S. Gastric Pharmacobezoar of Mesalamine Tablets Retrieved Endoscopically. ACG Case Rep J. 2017 Mar 1;4:e31. (License: CC BY-NC-ND-4.0)