Endoscopic treatment of a large gastric bezoar: A Case report

Yıl 2022, Cilt: 21 Sayı: 2, 103 - 107, 25.08.2022

Halil Yılmaz Mustafa Gürkan Haytaoğlu Mustafa Çelik Mustafa Yılmaz

https://doi.org/10.17941/agd.1163438

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

• 1. Singh SK, Marupaka SK. Duodenal date seed bezoar: a veryunusual cause of partial gastric outlet obstruction. Australas Radiol 2007;51:B126-9.
• 2. Kaneko H, Tomomasa T, Kubota Y, et al. Pharmacobezoar complicating treatment with sodiumalginate. J Gastroenterol 2004;39:69-71.
• 3. Coulter R, Antony MT, Bhuta P, Memon MA. Large gastric trichobezoar in a normal healthy woman: case report and reviewof pertinent literature. South Med J 2005;98:1042-4.
• 4. Kadian RS, Rose JF, Mann NS. Gastric bezoars --- spontaneous resolution. Am J Gastroenterol 1978;70:79-82.
• 5. DeBakey M, Oshner A. Bezoars and concretions. Surgery1938;4:934-63.
• 6. Jain SA, Agarwal L, Khyalia A, Chandolia P, Kaknale H. Pharmacobezoar-a rare case presented as gastric outlet obstruction. J Surg Case Rep 2018;2018:rjy116.
• 7. Abou Azar S, Wehbe MR, Jamali S, Hallal A. Small bowel obstruction secondary to a metamucil bezoar: Case report and review of the literature. Case Rep Surg 2017;2017:2702896.
• 8. AlQaseer A, AlHarmi RAR, AbuAli N, Ahmed M. Rare case of trichobezoar causing pancreatitis in a young woman. BMJ Case Rep 2019;12:e229173.
• 9. Chintapalli KN. Gastric bezoar causing intramural pneumatosis. J Clin Gastroenterol 1994;18:264-5.
• 10. Valberg LS, McCorriston JR, Partington MW. Bezoar: an unusual cause of protein-losing gastroenteropathy. Can Med Assoc J 1966 Feb;94:388-91.
• 11. Zarling EJ, Thompson LE. Nonpersimmon gastric phytobezoar. A benign recurrent condition. Arch Intern Med 1984;144:959-61.
• 12. Sechopoulos P, Robotis JF, Rokkas T. Gastric bezoar treated endoscopically with a carbonated beverage: case report. Gastrointest Endosc 2004;60:662-4.
• 13. Gold MH Jr, Patteson TE 3rd, Green GI. Cellulase bezoar injection: a new endoscopic technique. Gastrointest Endosc 1976;22:200-2.
• 14. Park SE, Ahn JY, Jung HY, et al. Clinical outcomes associated with treatment modalities for gastrointestinal bezoars. Gut Liver 2014;8:400-7.
• 15. Hu X, Zhang RY, Liu WH. A novel endoscopic treatment for giant gastric bezoars: guidewire-based seesaw-type fragmentation using a specific bezoaratom kit. Endoscopy 2020;52:E146-7.