Bezoar gástrico gigante. Presentación de un caso / Giant gastric bezoar. Presentation of case / Bezoar gástrico gigante. Apresentação de um caso

RESUMEN Se realizó un reporte de un caso de paciente femenina de 48 años de edad, con antecedentes patológicos personales de hipertensión arterial, cardiopatía isquémica, arritmias cardíacas y neurosis depresiva e ingestión diaria de cuerpos extraños desde hace algunos años, la cual tenía el hábito de masticar fragmentos de espuma de poliestireno (poliespuma), los que diluía en gasolina para poderlos moldear, ablandar e ingerirlos posteriormente. La paciente acudió a la consulta de Gastroenterología por presentar epigastralgia, acidez, sensación de repletes gástrica posprandial, aun cuando solo podía digerir escasas cantidades de alimento. Se realizó endoscopia, donde se apreció a la entrada de la luz gástrica un bezoar gigante de consistencia dura, superficie lisa, no movible, que midió aproximadamente 6-7 cm de diámetro, que ocupó prácticamente el 50 % de la luz gástrica, correspondiente al fundus y cuerpo gástrico, con extensión hacia el antro. Los intentos de extraerlo por vía endoscópica fueron fallidos, por lo que se intervino quirúrgicamente y se extrajo el mismo. La paciente tuvo una evolución posoperatoria favorable y egresó a los siete días, con seguimiento por consulta externa y tratamiento médico ambulatorio.

ABSTRACT A 48-year-old female presented to gastroenterologist consultation with epigastralgia, heartburn, and sensation of postprandial gastric fullness even when she only could intake meal in small proportion. She had a history of hypertension, ischemic heart disease, and cardiac arrhythmias, depressive neurosis associated to the ingestion, daily and since several years, of foreign bodies. She was used to chewing fragments of polyfoam, which she diluted them in gasoline in order to mold them, soften them and ingests them afterwards. An endoscopy procedure was used, which revealed, at the entrance of the gastric lumen, a giant bezoar of hard mass, smooth surface, non-movable, with approximately 6-7 cm size and occupying almost 50% of the gastric lumen region corresponding to the gastric body and fundus, and extending to the antrum. Attemps for removal the mass, endoscopically, were unsuccessful, so surgery was performed and it was removed successfully. The patient had a favorable postoperative evolution and was discharged 7 days after surgery, with outpatient follow-up and ambulatory medical treatment.

RESUMO Relatou-se o caso de uma paciente do sexo feminino, 48 anos, com história patológica pessoal de hipertensão arterial, cardiopatia isquêmica, arritmias cardíacas e neurose depressiva e ingestão diária de corpos estranhos há alguns anos, que tinha hábito de mastigar fragmentos de espuma de poliestireno (polyfoam), que ele diluiu em gasolina para poder moldar, amolecer e ingerir depois. A paciente compareceu à consulta de Gastroenterologia por apresentar epigastralgia, azia, sensação de plenitude gástrica pós-prandial, embora só conseguisse digerir pequenas quantidades de alimentos. Foi realizada endoscopia, onde um bezoar gigante de consistência dura, superfície lisa, imóvel, medindo aproximadamente 6-7 cm de diâmetro, ocupando praticamente 50% da luz gástrica, correspondente à luz gástrica, foi observado na entrada do lúmen gástrico, fundo e corpo gástrico, com extensão em direção ao antro. As tentativas de removê-lo endoscopicamente não tiveram sucesso, então ele foi submetido a uma cirurgia e foi removido. O paciente teve evolução pós-operatória favorável, com alta hospitalar sete dias após, com acompanhamento ambulatorial e acompanhamento médico ambulatorial.

Laparoscopic Surgery for Removal of the Multiple Large Gastric Bezoars

Bezoars are retained concretions of undigested animal or vegetable material that can produce gastrointestinal obstruction, ulceration, and bleeding. Therapeutic options for gastric bezoars include enzyme therapy (papain, cellulase, or acetylcysteine), endoscopic disruption and removal, and surgical removal. Multiple large gastric bezoars generally require conventional surgical management through an upper abdominal incision. With the recent improvement of laparoscopy, a lot of portions of abdominal operations have been performed laparoscopically. We successfully removed multiple large gastric phytobezoars in a 52-year-old female completely through laparoscopy. This supported the feasibility of laparoscopic surgery for patients with gastric bezoars.

A Huge Gastric Bezoar That Was Removed by Endoscopic Combination Therapy with an Argon Plasma and Coca-Cola Injection / 대한소화기내시경학회지

Bezoars are collections or concretions of indigestible foreign material in the gastrointestinal tract. In the past, the most common method for the treatment of bezoar was surgical management. The current treatment methods for bezoars include chemical dissolution and endoscopic lithotripsy using biopsy forceps and, snare, electrohydraulic lithotripsy and laser. Cases of endoscopic fragmentation of gastric bezoars using an argon plasma and dissolution of gastric bezoars with Cola have recently been described, but it took a long time in those cases to remove a bezoar by a single method. Moreover, fragmented, residual bezoar-related complications sometimes occurred. We report here on a case of a 35-year-old man with a 10x8x8 cm sized huge gastric bezoar that was successfully removed by combination therapy using an argon plasma and Coca-Cola injection. Compared with the previous single method, combination therapy using an argon plasma and Coca-Cola injection shortened the procedure time and reduced the complications related to a fragmented, remaining bezoar.

2 Cases of Huge Bezoar in Geriatric Patients that Endoscopically Removed Through Direct Injection of Coca-Cola

In case of bezoar removal, pharmacotherapy has been performed within restrictive patients as well as therapeutic endoscopy has been restricted as to the size of bezoar and its hardness. In patients with huge and hard bezoars, that is unable to remove through endoscopy they need surgical removal. But in case of geriatric patient management, we can't overlook the complication of general anethesia and post operative wound infection. Thus we describe two case of geriatric patient that endoscopically removed bezoar through the medium of dissolved by Coca-Cola direct injection and lavage. We injected Coca-Cola directly to bezoar through the spray catheter and then Coca-Cola lavage daily two liters for three days. We could easily destroy dissolved huge bezoars by using of biopsy forcep and snare and than get rid of them endoscopically by use of basket. In case of geriatric patient management of huge gastric bezoar it is considered another choice for bezoar removal.

A Case of Gastric Bezoar Formed by Ingestion of Gypsum, and it was Treated Endoscopically Using Electrohydraulic Lithotripsy / 대한소화기내시경학회지

Gastric bezoars are collection of indigestible material in the stomach, and these can be classified into five broad categories: phytobezoar, trichobezoar, pharmacobezoar, lactobezoar and miscellaneous materials such as sand, stone and concrete (gypsum). The treatment of gastric bezoars has recently changed from surgical management to such nonsurgical interventions as enzymatic dissolution, nasogastric suctioning and endoscopic removal by polypectomy snare and basket. Up to the present, electrohydraulic lithotripsy has been a well established method for the treatment of urinary and hepatobiliary stones. We report here on a patient who had a huge gastric bezoar that was formed by the ingestion of gypsum, and this was treated with endoscopic electrohydraulic lithotripsy.

A Case Report of Surgical Removal of Gastric Bezoar Formed by Ingestion of Bond in AIDS Patient

Despite the increasing number of patients with human immunodeficiency virus (HIV) infection, surgical experience with these patients remains limited in Korea. Patient with HIV infection may require surgery for the reasons similar to those anyone else might need an operation for or because of problems related to their viral illness. Surgeons feel threatened by the risk of contamination when operating on HIV-seropositive or AIDS patients. However, the exclusion of patients from treatment is unethical on ground of contamination risk. Therefore the surgeons have to reconsider their surgical strategy and technique in order to keep chances of contamination as low as possible. We report a case in which the AIDS patient has undergone an operation for gastric bezoar. To our Knowledge, this is the first report of laparotomy in Korea in patient with AIDS.

A Case of Diabetic Gastroparesis Complicated with a Gastric Bezoar / 대한소화기내시경학회지

Diabetic gastroparesis is a common gastrointestinal complication which develops in about 20-30% of patients with longstanding diabetes mellitus. Recent studies have shown that erythromycin stimulates gastrointestinal motor activity by binding on motilin receptors of gastrointestinal smooth muscles and that it improves gastric emptying in patients with diabetic gastroparesis. In this respect, we present a 35-year-old patient with diabetic gastroparesis, complicated with a gastric bezoar, who was successfully treated with endoscopic bezoar fragmentation and oral erythromycin for 3 weeks.