J Korean Surg Soc.  2009 Sep;77(3):177-183. 10.4174/jkss.2009.77.3.177.

The Clinical Analysis of 12 Cases of Bezoars

• Park JS
• Lee JI
• Jeong JH
• Lee JH
• Moon HJ
• Park JK
• Shin HJ

• KMID: 2004216
• DOI: http://doi.org/10.4174/jkss.2009.77.3.177

Abstract

PURPOSE
Bezoars are the uncommon result of ingestion of poorly digestible or indigestible substances. It is defined as retained concretions of animal or vegetable material in the gastrointestinal tract. The aim of this study was to review and analyze in these cases with reviewing literature. METHODS: The medical records of 12 cases, treated between May 1999 and April 2009, were reviewed. The clinical characteristics, as well as the diagnostic evaluations and results of medical and surgical treatment, were also analyzed retrospectively. RESULTS: Of the 12 cases, 6 men and 6 women, the bezoars were in the stomach, jejunum and ileum or in both stomach and jejunum in 1, 2, 7 and 2 cases, respectively. 4 patients (33.3%) had a history of gastric or duodenal ulcer following previously received gastric surgery such as subtotal gastrectomy or truncal vagotomy with pyloroplasty. In 3 cases, the bezoars were found in operative field under the impression of intestinal obstruction due to adhesive ileus, which could not be found by preoperative radiologic evaluation. Among the 12 cases, 11 cases were successfully treated by operative and endoscopic removal, but 1 case expired due to sepsis. CONCLUSION: A bezoar occurs mainly in patients who have previously undergone a gastric operation. Surgeons should keep in mind the possibility of bezoars in patients presenting an intestinal obstruction following a past gastric operation. The principle of treatment for bezoars used to be surgery, but recently gastric bezoars are often treated by gastrofiberscopy.

Keyword

Bezoar; Intestinal obstruction; Acute abdomen

MeSH Terms

Abdomen, Acute
Adhesives
Animals
Bezoars
Duodenal Ulcer
Eating
Female
Gastrectomy
Gastrointestinal Tract
Humans
Ileum
Ileus
Intestinal Obstruction
Jejunum
Male
Medical Records
Retrospective Studies
Sepsis
Stomach
Vagotomy, Truncal
Vegetables
Adhesives

Figure

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  Fig. 1 Monthly incidence of bezoars.

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  Fig. 2 The computed tomogram and operative finding of jejunal bezoar with SMA syndrome. (A) The arrow shows conglomerated jejunal phytobezoa. (B) Compressed duodenum with passage disturbance of gastrograffin by SMA. The arrow shows SMA. (C) The bezoar was removed via duodenojejunostomy.

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  Fig. 3 The obstructive ileal phytobezoar (A) which could not be found in preoperative evaluation was identified after laparotomy extracted bezoar (B) via ileotomy.

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