Oclusión intestinal en paciente renal crónico secundario a bezoar de telas Reporte de un caso clínico / Intestinal Occlusion in a Chronic Renal Patient Secondary to Textile Bezoar. Clinical Case Report

Resumen Los "bezoar" son conglomerados de materiales no comestibles ingeridos voluntaria o involuntariamente, no digeridos e incapaces de transitar por el tracto intestinal. Principalmente afectan a jóvenes mujeres o adolescentes que presentan el fenómeno llamado "pica", y a pesar de que se ha registrado una alta prevalencia de este fenómeno en pacientes con enfermedad renal crónica (ERC), ha sido poco estudiado. Caso clínico: Paciente del sexo masculino de 35 años de edad que cursa con ERC KDIGO-5 en tratamiento con diálisis peritoneal; se obtiene el hallazgo de "bezoar plástico" transoperatorio (laparotomia por oclusión intestinal) a 10 cm de la válvula ileocecal. El paciente fallece por complicaciones de la patología de origen. Se plantea la necesidad de realizar la búsqueda de comportamientos en pacientes con ERC, que indiquen al cirujano la sospecha, dado que los pacientes generalmente ocultan u omiten referir sobre la ingesta de material extraño.

Abstract The "bezoar" are conglomerates of inedible materials ingested voluntarily or involuntarily, which are not digested and are unable to pass through the intestinal tract. They mainly affect young women or adolescents who present the phenomenon called "pica", despite the fact that a high prevalence of this phenomenon of "pica" has been registered in patients with chronic kidney disease, it has been little studied. Clinical case: A 35-year-old male with CKD KDIGO-5 undergoing peritoneal dialysis treatment, which was found to have a transoperative "plastic bezoar" (laparotomy for intestinal occlusion) 10 cm from the ileocecal valve. The patient died due to complications of his pathology. Discussion: the clinical case raises the need to search for behaviors such as pica in patients with CKD, as well as to develop the suspicion to the surgeon, since patients generally hide or ignore reporting foreign material phagia.

Determination and difference analysis of bile acid active constituents of artificial bezoar in Babao jingfeng powder from different manufacturers / 中国药房

OBJECTIVE To establish the method for determination of bile acid active constituents （cholic acid， hyodeoxycholic acid and sodium taurocholate） in Babao jingfeng powder， and to compare the differences of 3 constituents in Babao jingfeng powder from different manufacturers. METHODS UPLC-MS method was adopted to determine the contents of cholic acid， hyodeoxycholic acid and sodium taurocholate in 9 batches of Babao jingfeng powder from 3 manufacturers. The separation was performed on a Phenomenex Luna® C18 column with mobile phase consisted of acetonitrile-water （gradient elution） at a flow rate of 0.5 mL/min. The column temperature was 40 ℃ and the sample size was 2 μL. MS system was operated in a negative ion single quadrupole mode， and the m/z of cholic acid， hyodeoxycholic acid and sodium taurocholate were 407.2， 392.2 and 514.2， respectively. With the contents of three components as the index， cluster analysis and principle component analysis were performed on 9 batches of samples. RESULTS The linear ranges of cholic acid， hyodeoxycholic acid and sodium taurocholate were 5.48- 548.40， 5.38-538.40， 4.74-474.05 ng/mL， respectively （r≥ 0.999 3）. RSDs of precision， repeatability and stability tests（24 h） were all lower than or equal to 3.7% （n＝6）， and the average recoveries were 103.3%， 103.3% and 101.6% with RSDs of 3.3%， 3.4%， 4.2% （n＝6）， respectively. The contentsof cholic acid ranged 0.702-1.711 mg/g， those of deoxycholic acid ranged 0.599-2.049 mg/g， and those of sodium taurocholate ranged 0.664-1.752 mg/g in 9 batches of samples. The average content of 3 components in samples from manufacturer A was high， and the difference between batches was the smallest； the average content of 3 components from manufacturer C was the lowest， and the difference between batches was large. Cluster analysis could basically distinguish samples from different manufacturers； cluster analysis was conducted by using the comprehensive score of principal components as an indicator， the results of which were basically consistent with those of cluster analysis for content. CONCLUSIONS The method is established successfully for the content determination of the 3 bile acid active constituents of artificial bezoar in Babao jingfeng powder. The contents of 3 components in Babao jingfeng powder from 3 manufacturers are significantly different.

The Role of Non-Contrast CT in the Diagnosis of a Rare Cause of Small Bowel Obstruction Due to Bezoar

@#Contrast Enhanced CT Abdomen is usually used to investigate the source of the small bowel obstruction. A 13-year old girl presented with signs of small bowel obstruction and was complicated with acute renal injury. Non-contrast CT Abdomen showed findings consistent with bezoar, and the findings are similar to the features seen in a contrast study. This case shows that both the plain and the contrast CT abdomen give similar findings of bezoar, one not inferior to the other.

Hemorragia digestiva alta. Una presentación inusual del síndrome de Rapunzel / Upper gastrointestinal bleeding. An unusual presentation of Rapunzel Syndrome

Los bezoares gastrointestinales son agregados no digeribles que fueron previamente ingeridos, el tricobezoar se sitúa dentro de la clasificación de éstos, su composición es de cabellos y restos alimentarios, tiene como ubicación más frecuente al estómago y rara vez se extiende hacia duodeno, yeyuno, íleon e incluso colon, condición entonces denominada síndrome de Rapunzel. Es una entidad rara, con incidencias que van desde 0.068% - 0.43%. Los pacientes a menudo muestran sintomatología digestiva inespecífica, como: dolor abdominal difuso, náuseas, vómitos, pobre ganancia de peso, ictericia obstructiva, enteropatía por pérdida de proteínas, masa abdominal y suele asociar además síntomas psiquiátricos . Se presenta el caso de una paciente de 7 años con hemorragia digestiva alta como debut de enfermedad, secundario a tricobezoar.

Gastrointestinal bezoars are indigestible aggregates that were previously ingested, the trichobezoar were placed within the disposition classification, its composition is hair and food remain, its most frequent location is the stomach and rarely extends to the duodenum, jejunum, ileum and even the colon, a condition then called Rapunzel syndrome. It is a rare entity, with incidences ranging from 0.068% - 0.43%. Patients often show digestive symptoms, such as: unexpected diffuse abdominal pain, nausea, vomiting, poor weight gain, obstructive jaundice, protein-loss enteropathy, abdominal mass, and often also associate psychiatric symptoms. We present the case of a 7-year-old patient with upper gastrointestinal bleeding as a disease debut, secondary to trichobezoar.

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.

Quantitation and content investigation of bilirubin in cultured cow-bezoar / 中国中药杂志

A determination method for bilirubin in cultured cow-bezoar was developed in this study, with which the bilirubin in 15 batches of samples was quantified. The samples were first processed with 10% oxalic acid solution for the conversion of bilirubin from conjugated to unconjugated, followed by the extraction with dichloromethane. Then the obtained sample solutions were analyzed at 450 nm by HPLC[chromatographic column: Agilent TC-C_(18)(4.6 mm × 250 mm, 5 μm); mobile phase: acetonitrile and 1% glacial acetic acid aqueous solution(95∶5); flow rate: 1.0 mL·min~(-1)]. The bilirubin content in the 15 batches of cultured cow-bezoar was ranged from 21.9% to 41.7% with the average of 32.4%. The proposed method is accurate and reliable, thus making it suitable for the quantitation of bilirubin in cultured cow-bezoar and its quality assessment and control.

Determination of the Contents of Heavy Metals and Harmful Elements in Pediatric ，Paracetamol，Atificial Cow- bezoar and Chlorphenamine Maleate Granules by ICP-MS / 中国药房

OBJECTIVE：To es tablish a method for the content determination of heavy metals [lead （Pb），cadmium（Cd）， copper （Cu）， mercury （Hg）] and harmful elements [arsenic （As）] in Pediatric paracetamol artificial cow-bezoar and chlorphenamine maleate granules. METHODS ：The samples were conducted pretreatment by microwave digestion instrument and determined by inductively coupled plasma mass spectrometry （ICP-MS）using elements germanium ，indium，bismuth as internal standard. RESULTS ：The linear ranges of Pb ，As，Cu，Cd and Hg were 1-20，0.5-10，5-100，0.5-10 and 0.2-4 ng/mL， respectively （all r＞0.997）. The limits of detection （LODs） were 0.041 1，0.013 2，0.057 3，0.009 0，0.005 4 ng/mL， respectively. The limits of quantification （LOQs）were 0.137 0，0.044 0，0.191 0，0.030 0，0.018 0 ng/mL，respectively. RSDs of precision and repeatability tests were all less than 6％. RSDs of stability tests （28 h）of Pb ，As，Cu and Cd were all less than 5％， and that of stability test （28 h）of Hg was less than 7％. The average recoveries were 89.44％（RSD＝5.87％，n＝9），99.56％ （RSD＝5.46％ ，n＝9），96.12％（RSD＝4.62％ ，n＝9），105.82％（RSD＝2.80％ ，n＝9）and 90.23％（RSD＝3.59％ ，n＝9）， respectively. Five elements were all detected in 63 batches of samples ，and the contents of them were 0.191 0-1.527 6，0.002 5- 0.047 4，0.034 1-1.549 0，0.001 5-0.078 8 and 0.001 9-0.005 4 mg/kg，respectively. CONCLUSIONS ：The method is simple ， sensitive and accurate. It is suitable for simultaneous determination of 5 elements in Pediatric paracetamol artificial cow-bezoar and chlorphenamine maleate granules.

Evaluation Effectiveness of in Vitro Cultivation of Bezoar on Mouse Model Combining Disease with Syndrome of Coronavirus Pneumonia with Yidu Xifei Syndrome / 中国实验方剂学杂志

Objective:To determine the therapeutic effect of <italic>in vitro</italic> cultivation of bezoar on a mouse model adding disease with syndrome of coronavirus pneumonia with Yidu Xifei syndrome. Method:BALB/c mice were randomly divided into six groups according to their weight grade： normal group， HCoV-229E infection group， cold and damp group， a mouse model combining disease with syndrome of coronavirus pneumonia with Yidu Xifei syndrome， and high and low dose group of <italic>in vitro</italic> cultivation of bezoar. The combination model of human coronavirus pneumonia with Yidu Xifei syndrome mice was established by the method of cold dampness condition stimulation+coronavirus HCoV-229E infection. <italic>In vitro</italic> cultivation of bezoar （0.128，0.064 g·kg^-1） was administrated by gavage for 3 days from the day of infection. The observation indexes included： general state observation of mice， inhibition rate of lung index and lung index of mice. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） was used to detect the viral load in the lung tissues of mice. Serum levels of motilin（MTL）， gastrin （GAS）， and cytokines interleukin（IL）-10，IL-6， tumor necrosis factor-<italic>α</italic>（TNF-<italic>α</italic>）and interferon-<italic>γ</italic>（IFN-<italic>γ</italic>） in lung tissue of mice were determined by enzyme-linked immunosorbent assay（ELISA）. The percentages of CD4⁺ T lymphocytes，CD8⁺ T lymphocytes and B lymphocytes in the blood of mice were determined by flow cytometry. Result:The high and low dose group of <italic>in vitro</italic> cultivation of bezoar can significantly improve the general condition of model mice. Compared with blank group， model group mice lung index increased significantly （<italic>P</italic><0.01）， nucleic acids significantly increased expression of lung tissue in mice （<italic>P</italic><0.01）， significantly higher serum MTL content in mice， GAS content significantly decreased （<italic>P</italic><0.05，<italic>P</italic><0.01）， lung tissue cells in the immune factor TNF-<italic>α</italic>， IL-10 and IL-6 were significantly increased （<italic>P</italic><0.01）， peripheral blood lymphocyte CD4⁺ T cells in mice， The percentages of CD8⁺ T cells and B cells were significantly decreased （<italic>P</italic><0.01）. Compared with model group， <italic>in vitro</italic> cultivation bezoar mice lung index of high and low dose group were significantly lower （<italic>P</italic><0.01）， the lung tissue of mice express nucleic acid decreased significantly （<italic>P</italic><0.01）， MTL content decreased significantly （<italic>P</italic><0.01）， the lung tissue of mice in the IL-6， IL-10， the TNF-<italic>α</italic>， IFN-<italic>γ</italic> levels were significantly lower （<italic>P</italic><0.01）， <italic>in vitro</italic> cultivation bezoar high dose group can significantly increase the CD4⁺ T cell percentage （<italic>P</italic><0.05）， <italic>in vitro</italic> cultivation bezoar can to a certain extent reduce model mice lung inflammatory exudation， pulmonary interstitial edema， as well as blood stasis symptoms. Conclusion:<italic>In vitro</italic> cultivation of bezoar has a significant therapeutic effect on a mice model adding disease with syndrome of coronavirus pneumonia with Yidu Xifei syndrome. It can be treated by reducing the lung index of the model mice， improving the pathological damage of the lung tissue， adjusting the immune effective and inhibiting the clearing of inflammatory factors， and to provide a laboratory basis for clinical medication.

Síndrome de Rapunzel: mito o realidad / Rapunzel Syndrome: Myth or Reality

Resumen Se presenta el caso de una paciente de 35 años, quien ingresa al servicio de urgencias de un hospital de tercer nivel, por causa de un cuadro de 6 meses de saciedad precoz, pérdida de peso y, en el momento del examen físico de ingreso, se observan signos de desnutrición. En consecuencia, se realiza una endoscopia de las vías digestivas altas en las que se descubre un tricobezoar que ocupa toda la cámara gástrica y se extiende más allá de la tercera porción del duodeno. Mediante una tomografía axial computarizada (TAC) de abdomen, se confirma la presencia de una lesión que ocupa la cámara gástrica y el duodeno, por lo que la paciente es conducida a cirugía. Allí se encuentra el tricobezoar que confirma el diagnóstico de síndrome de Rapunzel. Luego de la cirugía, la paciente presenta una adecuada evolución posoperatoria, con resolución de los síntomas de ingreso. Asimismo, se inicia una intervención por nutrición y psicología, a fin de manejar la desnutrición y el trastorno psiquiátrico de base.

Abstract A 35-year-old patient was admitted to the emergency department of a third-level hospital following six months of early satiety and weight loss. Upon physical admission, the patient had signs of malnutrition. Upper digestive tract endoscopy found a trichobezoar that occupied the entire gastric chamber and extended into the third portion of the duodenum. This diagnosis was confirmed by an abdominal CT scan. Surgery confirmed the diagnosis of Rapunzel Syndrome. Following surgery the patient's evolution was good and symptoms resolved. Nutritional and psychological interventions were initiated to manage malnutrition and an underlying psychiatric disorder.

Trichobezoars: a hairy cause of intestinal obstruction

Trichobezoars are an infrequent form of bezoar found in the stomach or intestine, created from ingested hair. Their most frequent location is in the stomach but they may extend through the pylorus into the small bowel. This condition is known as Rapunzel syndrome. Trichobezoar with Rapunzel syndrome is an uncommon diagnosis in children. Authors report 3 cases of Rapunzel syndrome with a large bezoar in paediatric age group that presented with features of acute intestinal obstruction. They were managed with surgical exploration.

Phytobezoar induced small bowel obstruction: an uncommon cause of intestinal occlusion

A case of a 42-year-old female patient with a two-days diffuse colicky abdominal pain, nausea and three episodes of vomiting is presented. Furthermore, patient complained for inability to eat for almost a week. In addition, patient had a history of subtotal gastrectomy Billroth II-type, due to gastric ulcer six years ago. There were no other known co-morbidities. Except for a distended, somewhat painful abdomen and sluggish bowel sounds, the rest clinical examination was unremarkable. Plain abdominal X-ray and ultrasound findings agreed with the clinical suspicion of sub-acute small bowel obstruction probably due to post-operative adhesions. A conservative management was decided. However, the patient after an initial clinical improvement, had a relapse of symptoms with the first feeding attempt. A followed computed tomography of the abdomen revealed a well define, oval, mass-like containing mostly air bubbles lesion, occupying for approximately six centimeters long the jejunum lumen. The diagnosis of jejunal phytobezoar was set. In accordance of computed tomography diagnosis were the intra-operative findings and the post-operative histopathology.

Lithobezoar: a case report

We present a unique case of a colonic lithobezoar in a relatively healthy, young male with no history of psychological or psychiatric disorders. Furthermore, unlike previously reported cases, this patient had no history of gastric surgery. The mode of presentation and the rariety of disease pose difficulties in diagnosis of lithobezoar. The different modalities of treatment, both surgical and nonsurgical, were thought of and discussed. The diagnosis of a lithobezoar in a healthy patient requires a high index of suspicion, as it presents with nonspecific symptoms. The standard treatment for bezoars is discussed but lithobezoar needs special mention due to its rariety and no specific surgery guidelines.

Investigation of chemical profile of bile acids and determination of them in cultured Bovis Calculus with UPLC-QDA / 中国中药杂志

In this study, 10 batches of samples of cultured Bovis Calculus(cow-bezoar) were determined for the investigation of chemical profile of bile acids with the UPLC-QDA method established. The results showed that nine common bile acids, cholic acid(CA), deoxycholic acid(DCA), chenodeoxycholic acid(CDCA), taurocholic acid(TCA), taurodeoxycholic acid(TDCA), taurochenodeoxycholic acid(TCDCA), glycocholic acid(GCA), glycodeoxycholic acid(GDCA) and glycochenodeoxycholic acid(GCDCA), were founded in samples and 7 bile acids were quantified except GDCA and GCDCA. In these samples, unconjugated bile acids, the major type of bile acids, accounted for more than 97% of all types of bile acids. As for unconjugated bile acids, CA was the most major bile acid in cultured cow-bezoar and it was about twice as much as DCA. The relative low-cost method established in the current study is accurate, rapid and sensitive, which is suitable for the studies of other drugs from animal bile.

Trichobezoars as a cause of intestinal obstruction in a young female

A bezoar is a mass found trapped in the gastrointestinal system, though it can occur in other locations. There are various types of bezoars including food boluses, lactobezoar, pharmacobezoar, phytobezoar, diospyrobezoar and trichobezoar. They are common in children and adolescents, and 90% of the patients are women. Complications may manifest as gastric outlet obstruction or bleeding and intestinal obstruction. CT is the preferred image modality for the evaluation of suspected trichobezoars in order to characterize the size, location, presence and level of obstruction and complications such as ischemia or perforation. Here authors present a case to stress the importance of considering trichobezoars as one of the causes for intestinal obstruction in young females.

Studies on Plastic Bezoar Ingestion in Free Range Axis Deer in Summer

The objectives of this study were to investigate growth patterns of Sirohi goat applying the Brody function and estimated the parameters of growth curve including genetic evaluation of growth curve traits. The data used in this study, collected in All India Co-ordinated Research Project (AICRP) on goat improvement, Livestock Research Station, Vallabhnagar, Udaipur, India from year 2009 to 2017 and were included 340 male and 715 female kids body weight measured at birth to 12th month of age in every three months interval. Least-squares means for growth curve parameters of A (Asymptotic weight), B (folding point of growth) and K (maturity rate) were 26.18±3.11 (kg), 0.88±0.00 (kg) and 0.16±0.00 (days), respectively. Fixed effects (cluster, year and season of birth, sex, and type of birth) were significantly influenced the parameters of growth curve. The heritability estimates ranged from 0.02±0.01 (“K”) to 0.40±0.05 (“A”). The genetic correlation between A-K and B-K was negative, which might be due to the compensatory growth effect"

Fungal pneumaturia: A case report on a large urinary bladder fungal bezoar in a young diabetic male

@#Fungal bezoars or fungus balls are extremely rare cases especially when they occur within the urinary tract. Reported here is a 26-year old diabetic male presenting with pneumaturia, passage of debris per urethra and lower urinary tract symptoms. He was initially managed as a case of enterovesical fistula. Further work-up revealed a urinary bladder fungal bezoar. The patient was managed by endoscopic morcellation and evacuation of the fungal ball from the bladder and anti-fungal therapy. Awareness of this rare clinical entity and its presentation will aid in its proper diagnosis and management.

Fitobezoar posterior a mini bypass gástrico por laparoscopia / Phytobezoar after mini gastric bypass

Introducción. La miniderivación (mini-bypass) gástrica por laparoscopia es un procedimiento bariátrico que recientemente ha cobrado popularidad. Las alteraciones del tubo digestivo generadas por estos procedimientos pueden ocasionar diversas complicaciones, algunas raras, como los bezoares.Caso clínico. Se presenta el caso de una mujer de 52 años de edad con antecedentes de diabetes mellitus y obesidad, que fue tratada con una miniderivación gástrica por laparoscopia. Nueve meses después del procedimiento, presentó dolor en el epigastrio, intolerancia a los alimentos y vómito, por lo cual se dio tratamiento sintomático sin obtener mejoría. Se practicó una endoscopia de vías digestivas altas, cuyo hallazgo fue un bezoar de coco que obstruía parcialmente la anastomosis. El bezoar se trituró y se extrajo por endoscopia. Discusión. Los pacientes con antecedentes de cirugía bariátrica tienen mayor riesgo de presentar bezoares por la modificación del tubo digestivo. Estos pacientes presentan frecuentemente síntomas de dispepsia, por lo que la sintomatología inespecífica puede confundirse o subestimarse. Se debe considerar practicar una endoscopia en todos aquellos con antecedentes de cirugía bariátrica que presenten vómito persistente después de ingerir alimentos o síntomas de obstrucción gástrica

Introduction: Laparoscopic Mini-gastric bypass is a bariatric procedure that has gained popularity recently. Alterations to the gastrointestinal tract anatomy created during these procedures, may lead to several complications, some of them very rare, such as the bezoar. Presentation of case: A fifty-two years old female with type II diabetes mellitus and obesity was treated by laparoscopic mini-gastric bypass surgery. Nine months after her surgery she experienced epigastric pain, intolerance to food and vomiting with non-successful symptomatic treatment. One month later, the patient underwent an upper GI endoscopy which reported a coconut bezoar partially obstructing the anastomosis. Bezoar was broken into pieces and removed endoscopically. Two days after, patient returned to normal diet. Conclusion: Patients with bariatric surgeries have a higher risk of presenting such masses because of the gas-trointestinal tract modifications. Symptoms can be confused or overlooked in bariatric patients since there is a frequent complain of dyspeptic symptoms after such procedures. An endoscopy should be considered in every patient who underwent a bariatric procedure and presents with persistent vomiting after food ingestion and/or gastric outlet symptoms

Tricobezoar: presentación de caso / Trichobezoar: presentation of case

Los tricobezoares pertenecen a la clasificación de los bezoares, tumores abdominales formados por el acumulo de diversas sustancias que pueden ocasionar la oclusión intestinal, se presenta un paciente, femenina, que acuda al médico por presentar dolor abdominal y vómitos, en el examen físico abdominal se palpa una masa de aproximadamente 5 cm en el epigastrio que aparece y desaparece con los movimientos intestinales, se plantea inicialmente la posibilidad de padecer de una neoplasia abdominal, se realiza una endoscopia en donde informe que, en el fondo gástrico, cuerpo y antro está ocupado por cabello y restos alimenticios mal digeridos, la cual es removida mediante una laparotomía sobre el área que ocupaba la tumoración en el intestino delgado extrayendo un tricobezoar de 35 cm de longitud por 10 de ancho(AU)

The trichobezoars belong to the classification of bezoars, abdominal tumors formed by the accumulation of various substances that can cause intestinal occlusion, a patient, female, who comes to the doctor due to abdominal pain and vomiting, in the abdominal physical examination is presented palpa a mass of approximately 5 cm in the epigastrium that appears and disappears with bowel movements, initially poses the possibility of suffering from an abdominal neoplasm, an endoscopy is performed where it reports that, in the gastric fundus, body and antrum is occupied by hair and badly digested food remains, which is removed by a laparotomy on the area occupied by the tumor in the small intestine, extracting a trichobezoar measuring 35 cm long by 10 cm wide(AU)

Clinics in diagnostic imaging (198). Small bowel obstruction secondary to a bezoar

A 60-year-old man presented with abdominal pain. He was later diagnosed on imaging to have high-grade small bowel obstruction. The patient underwent surgery, and a hard, rounded bezoar resembling the endosperm of Nypa fruticans, colloquially known as attap chee, was found at the point of obstruction. Small bowel obstruction is a common acute surgical condition with multiple causes, including bezoars. We discuss the typical imaging features of bezoars causing small bowel obstruction as well as potential pitfalls that can mimic the appearance of a bezoar.

Migration of a Percutaneous Endoscopic Gastrojejunostomy Tube into the Colon with Small Intestinal Telescoping

Continuous duodenal levodopa/carbidopa intestinal gel delivery by a gastrostomy infusion system improves control of Parkinson’s disease. The overall complication rates of percutaneous endoscopic gastrojejunostomy were reported to be 41% and 59% for immediate and delayed adverse events, respectively. A 72-year-old woman underwent percutaneous endoscopic gastrojejunostomy using the delivery system noted above. Abdominal pain and vomiting occurred 3 months later. Esophagogastroduodenoscopy showed a longitudinal ulcer extending from the lower gastric body to the ileum end, with small intestinal telescoping. Colonoscopy showed a large bezoar of food residue that was attached around the tip of the tube, reaching the ascending colon, which may have acted as an anchor. Thus, the gastric antrum and small intestine were shortened with telescoping. This complication was resolved by crushing the bezoar with forceps during colonoscopy and can be prevented by consuming a fiber-free diet and periodic exchanges of the tube using esophagogastroduodenoscopy.