Clin Endosc.  2015 Sep;48(5):436-439. 10.5946/ce.2015.48.5.436.

Megaduodenum with Duodenal Diospyrobezoars

• Park HW
• Lee HS

• KMID: 2148557
• DOI: http://doi.org/10.5946/ce.2015.48.5.436

Abstract

Bezoars are retained masses of ingested materials accumulating within the gastrointestinal track. While gastric bezoars are often observed, duodenal bezoars are rarely reported. A 77-year-old man who had frequently consumed persimmons and had never undergone gastric surgery had symptoms of epigastric pain and early satiety for 10 days. Esophagogastroduodenoscopy showed many diospyrobezoars in a severely distended duodenal bulb, otherwise known as megaduodenum. The patient's treatment consisted of repeated endoscopic removal of the bezoars by using a retrieval net.

Keyword

Bezoars; Megaduodenum; Endoscopy; Removal

MeSH Terms

Aged
Bezoars
Diospyros
Endoscopy
Endoscopy, Digestive System
Humans

Figure

• 

  Fig. 1 Endoscopic findings. (A) Bezoars were observed through the pyloric ring. (B) Bezoars were removed using a retrieval net.

• 

  Fig. 2 Endoscopic findings. (A) When the endoscope was turned to the pylorus in the distended duodenal bulb after the endoscopic removal of the bezoars, the pylorus looked like the cardia of the stomach. (B) As the duodenal bulb was severely distended, the upper gastrointestinal endoscope could not pass into the distal duodenum.

• 

  Fig. 3 Abdominal computed tomography (CT) gastrography and upper gastrointestinal contrast study findings. (A) Abdominal CT gastrography showed that the proximal duodenal portion (arrow) was distended and a small amount of undigested food materials was present in the lumen a week after the endoscopic removal of the bezoars. (B) Upper gastrointestinal contrast study showed a movable mass-like lesion in the severely distended proximal duodenal portion (arrow) a week after the endoscopic removal of the bezoars.

Reference

1. Yang JE, Ahn JY, Kim GA, et al. A large-sized phytobezoar located on the rare site of the gastrointestinal tract. Clin Endosc. 2013; 46:399–402. PMID: 23964339.

2. McKechnie JC. Gastroscopic removal of a phytobezoar. Gastroenterology. 1972; 62:1047–1051. PMID: 5029071.

3. de Toledo AP, Rodrigues FH, Rodrigues MR, et al. Diospyrobezoar as a cause of small bowel obstruction. Case Rep Gastroenterol. 2012; 6:596–603. PMID: 23271989.

4. Lytras D, Olde-Damink SW, Imber CJ, Hatfield A, Amin Z, Malago M. Duodenal web in an adult presenting with acute pancreatitis and acquired megaduodenum: report of a case. Surg Today. 2011; 41:426–429. PMID: 21365431.

5. Karstensen J, Raahave D, Kirkegaard P. Mega-duodenum and constipation after surgery for congenital atresia of the jejunum. Ugeskr Laeger. 2011; 173:1808–1809. PMID: 21689512.

6. Barnett WO, Wall L. Megaduodenum resulting from absence of the parasympathetic ganglion cells in Auerbach's plexus; review of the literature and report of a case. Ann Surg. 1955; 141:527–535. PMID: 14362386.

7. Zhang XW, Abudoureyimu A, Zhang TC, et al. Tapering duodenoplasty and gastrojejunostomy in the management of idiopathic megaduodenum in children. J Pediatr Surg. 2012; 47:1038–1042. PMID: 22595598.

8. Mansell PI, Tattersall RB, Balsitis M, Lowe J, Spiller RC. Megaduodenum due to hollow visceral myopathy successfully managed by duodenoplasty and feeding jejunostomy. Gut. 1991; 32:334–337. PMID: 1901564.

9. Boeckxstaens GE, Rumessen JJ, de Wit L, Tytgat GN, Vanderwinden JM. Abnormal distribution of the interstitial cells of cajal in an adult patient with pseudo-obstruction and megaduodenum. Am J Gastroenterol. 2002; 97:2120–2126. PMID: 12190188.

10. Kudoh K, Shibata C, Funayama Y, et al. Gastrojejunostomy and duodenojejunostomy for megaduodenum in systemic sclerosis sine scleroderma: report of a case. Dig Dis Sci. 2007; 52:2257–2260. PMID: 17420947.

11. Singh SK, Marupaka SK. Duodenal date seed bezoar: a very unusual cause of partial gastric outlet obstruction. Australas Radiol. 2007; 51(Spec No.):B126–B129. PMID: 17875133.

12. Lee BJ, Park JJ, Chun HJ, et al. How good is cola for dissolution of gastric phytobezoars? World J Gastroenterol. 2009; 15:2265–2269. PMID: 19437568.

13. Ha SS, Lee HS, Jung MK, et al. Acute intestinal obstruction caused by a persimmon phytobezoar after dissolution therapy with Coca-Cola. Korean J Intern Med. 2007; 22:300–303. PMID: 18309693.

14. Nichol PF, Stoddard E, Lund DP, Starling JR. Tapering duodenoplasty and Roux-en-Y duodenojejunostomy in the management of adult megaduodenum. Surgery. 2004; 135:222–224. PMID: 14739858.