Endoscopic treatment of a large gastric bezoar: A Case report

Öz

Bezoars are concretions of undigested or partially digested foreign material in the gastrointestinal tract. They occur in patients with altered gastrointestinal motility or anatomy (previous gastricsurgery, diabetes mellitus, neurological disorders). They are rare, with an estimated %0.3 on upper endoscopy. The most common symptoms include abdominal pain, nausea, vomiting, early satiety, anorexia, and weight loss. We present a patient who diagnosed with 8-9 cm phytobezoar, and treated by endoscopic method. An 87 years old woman presented to our emergency room with upper abdominal pain, nausea, and postprandial emesis for 3 days. Emergency esophagogastroduodenoscopy revealed prepyloric antrum, gastric phytobezoar (8-9 cm) and ulcers (10-12 mm). We used an endoscopic snare to cut the bezoar into several pieces. After endoscopy, all bezoars disappeared. There was no recurrence during 1-year follow-up. In conclusion, endoscopic treatment may be a safe and viable option for the extraction of gastric bezoars presenting with gastric outlet obstruction. This is the rare case that such a large phytobezoar (8×9 cm) has been fragmented with an ordinary polypectomy snare.

Anahtar Kelimeler

• Gastric bezoar
• endoscopy
• treatment

Büyük gastrik bezoarın endoskopik tedavisi: Vaka sunumu

Öz

Bezoarlar gastrointestinal sistemde sindirilmemiş veya kısmen sindirilmiş yabancı materyallerin konsantre olmuş halidir. Genelde bozulmuş gastrointestinal motilite veya anatomisi olan hastalarda (geçirilmiş gastrik cerrahi, diabetes mellitus, nörolojik bozukluklar) görülür. Nadir karşılaşılan bu duruma üst gastrointestinal endoskopilerin %0.3’ünde rastlanır. Sıklıkla karın ağrısı, bulantı, kusma erken doyma, anoreksi ve kilo kaybı gibi semptomlar görülür. Bu sunumda 8-9 cm’lik bezoar saptanan ve endoskopik yöntemle tedavi ettiğimiz hastamızı paylaştık. 87 yaşında bayan hasta, üç gündür olan karın ağrısı, bulantı ve kusma şikayetleri ile acil servisimize başvurdu. Yapılan endoskopide prepilorik antruma oturmuş 8-9 cm’lik bezoar ve altında 10-12 mm’lik ülser görüldü. Bezoar snare ile parçalara bölündü. Endoskopi sonrası hasta takibe alındı ve 1 gün sonra yapılan endoskopide tüm bezoar parçalarının kaybolduğu görüldü. Hastanın 1 yıllık takibinde bezoar tekrarlamadı. Sonuç olarak endoskopik tedavi gastrik çıkış obstrüksiyonu ile gelen bezoar hastalarında güvenilir ve etkin bir yöntemdir. Bu kadar büyük bir gastrik bezoarın polipektomi snare kullanılarak, endoskopik yöntemle parçalandığı bu vaka literatürde nadir bir sunumdur.

Anahtar Kelimeler

• Gastrik bezoar
• endoskopi
• tedavi

Kaynakça

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