Fitobezoar disuelto químicamente con coca-cola / Chemically dissolved phytobezoar with coca-cola

Los bezoares han estado presentes en la historia de la medicina desde sus inicios, si bien su incidencia es baja y suelen detectarse de manera incidental, es importante tener opciones menos invasivas para su tratamiento debido a que la endoscopia digestiva alta (EDA) no está siempre disponible en todos los centros y, además, muchas veces no logra ser resolutiva debido al tamaño y/o composición del bezoar. En este reporte se presenta el caso de una paciente que, en el contexto de un posible síndrome de CREST, presentó un fitobezoar que fue disuelto con Coca-Cola®, un elemento ampliamente disponible alrededor del mundo, por lo que podría incluso llegar a considerarse como primera línea dentro del manejo no invasivo.

Bezoars have been present in the history of medicine since its inception, although their incidence is low and they are usually detected incidentally, it is important to have less invasive options for their treatment because upper digestive endoscopy (EDA) is not always available in all centers and, moreover, often fails to resolve due to the size and/or composition of the bezoar. This report presents the case of a patient who, in the context of a possible CREST syndrome, presented a phytobezoar that was dissolved with Coca-Cola®, an element widely available around the world, for which reason it could even be considered as the first line of non-invasive management.

Obstrução gástrica por bezoar / Gastric obstruction due to bezoar

A obstrução por bezoar é um acúmulo de material parcialmente ou não digerido no estômago. Bezoares gástricos são raros e ocorrem com mais frequência em pacientes com transtornos de comportamento, esvaziamento gástrico anormal ou após cirurgia gástrica. Podem ser assintomáticos ou apresentar sintomas como dor abdominal e vômitos incoercíveis. Podem ainda ter composições diversas e ocorrer em todas as faixas etárias. O objetivo deste relato foi demonstrar um caso de bezoar gástrico em paciente previamente submetido à cirurgia bariátrica e internado com quadro de vômitos incoercíveis e hemorragia digestiva alta, com a demonstração de que sua resolução completa ocorreu na realização da segunda endoscopia.

Bezoar obstruction is an accumulation of partially digested or undigested material in the stomach. Gastric bezoars are rare and occur more frequently in patients with behavioral disorders, abnormal gastric emptying, or after gastric surgery. They may be asymptomatic or present with symptoms such as abdominal pain and incoercible vomiting. They can have diverse compositions and occur in all age groups. The aim of this report was to demonstrate a case of gastric bezoar in a patient who previously underwent a bariatric surgery and was hospitalized with incoercible vomiting and upper gastrointestinal hemorrhage, with the demonstration that its complete resolution occurred during the second endoscopy.

The cause of abdominal mass in a child with celiac disease: Rapunzel syndrome. A case report

ABSTRACT CONTEXT: Rapunzel syndrome is a rare form of gastric trichobezoar that develops through outstretching of the bezoar from the stomach to the intestine. CASE REPORT: A 12-year-old girl who had been diagnosed with celiac disease six years earlier was brought to the department of pediatric gastroenterology because of abdominal distension. A palpable mass was detected. A trichobezoar that stretched to the small intestine was removed surgically. The patient was diagnosed as having anxiety and depressive disorder, and treatment started. Following the treatment, her previous trichophagia completely disappeared. CONCLUSION: Presence of trichobezoar should be kept in mind, especially when young girls who have psychiatric problems suffer from gastrointestinal symptoms.

Síndrome de Rapunzel gigante con complicación atípica: Reporte de un caso / Giant Rapunzel syndrome with atypical complication: Report of a case

El síndrome de Rapunzel es una forma inusual y rara de tricobezoar gástrico que se extiende al intestino delgado. La formación es debida a la ingestión continua de cabello la cual lleva a la impactación del mismo junto con moco y alimento, pero es infrecuente que se produzca perforación gástrica. Reportamos el caso de una paciente de sexo femenino de 16 años de edad admitida en nuestra institución con antecedentes de depresión y cuadro clínico caracterizado por náuseas, epigastralgia severa y pérdida patológica de peso. Al examen físico se evidenció un abdomen tenso con reacción peritoneal, la tomografía de abdomen contrastada evidenció un estomago distendido con contenido heterogéneo que se extiende hacia el duodeno, hidroneumoperitoneo y líquido en fondo de saco de Douglas, por lo que se le decidió realizar una laparotomía exploratoria que evidenció perforación en cara anterior de estómago que es una complicación infrecuente, por lo que se procedió a la extracción del tricobezoar gigante con extensión duodenal; evolucionando de forma favorable remitiéndose la paciente a controles ambulatorios con psiquiatría; finalmente se le realizó una endoscopía alta a los 6 meses que evidenció la cicatriz del procedimiento quirúrgico.

Rapunzel syndrome is an unusual and rare form of gastric trichobezoar that extends into the small intestine. The formation is due to the continuous ingestion of hair which leads to the impaction of the hair along with mucus and food, but it is rare that gastric perforation occurs. We report the case of a female patient of 16 years of age admitted to our institution with a history of depression and clinical symptoms characterized by nausea, severe epigastralgia and pathological loss of weight. The physical examination showed a tense abdomen with a peritoneal reaction. Contrast-enhanced tomography showed a distended stomach with a heterogeneous content that extended to the duodenum, hydro pneumoperitoneum, Douglas sack bottom liquid, and it was decided to perform an exploratory laparotomy. Showed perforation in the anterior face of the stomach which is infrequent, so we proceeded to the extraction of giant trichobezoar with duodenal extension; Evolving favorably, the patient being referred to outpatient controls with psychiatry; Finally, a high endoscopy was performed at 6 months, which evidenced the scar of the surgical procedure.

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)

Intestinal obstruction caused by phytobezoar composed of jaboticaba seeds: case report and literature review

Bezoar is a cluster of swallowed and undigested material in the gastrointestinal tract which can cause intestinal obstruction. It has multiple subtypes and the phytobezoar (composed of vegetable fiber) is the most common. We report a patient admitted with intestinal obstruction caused by impaction of multiples seeds of jaboticaba in the rectum. The treatment included multiple enemas, laxatives and digital maneuvers and it was effective after four days. Only one similar report was found in the literature. (AU)

Bezoar trata-se de um aglomerado de material deglutido e não digerido no trato gastrointestinal que pode causar quadro de obstrução intestinal. Existem múltiplos subtipos, sendo o mais comum o fitobezoar (composto por fibras vegetais). Foi relatado o caso de uma paciente admitida com quadro de suboclusão intestinal causada por impactação de múltiplos caroços de jabuticaba em reto. O tratamento instituído foi conservador com múltiplos enteroclimas, laxativos e quebra digital, efetivos após quatro dias. Somente um caso semelhante foi encontrado na literatura. (AU)

A case report on bezoar.

A nine years old girl was admitted into the paediatric surgery word of Dhaka Medical College Hospital (DMCH) with upper abdominal mass and discomfort, was diagnosed radiologically as a case of gastric bezoar which was further confirmed by endoscopy as trichobezoar (hair ball). The girl was undergone laparotomy and trichobezoar was removed from stomach by gastrostomy. After ten days of operation she became well and was discharged from the hospital.

An intragastric trichobezoar: computerised tomographic appearance.

A 26-year-old lady presented with a history of abdominal pain and distension since two months. The ultrasound examination showed an epigastric mass, which was delineated as a filling defect in the stomach on barium studies. The computerised tomographic scan showed a gastric mass with pockets of air in it, without post-contrast enhancement. This case highlights the characteristic appearance on computerised tomography of a bezoar within the stomach, a feature that is not commonly described in medical literature.