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PubMed1997

Bezoar formation and malabsorption secondary to persistent dilatation and dysmotility of the duodenum after repair of proximal jejunal atresia.

Bezoar formation is a rare but well-recognised complication of previous gastric surgery and persimmon ingestion. We present a case of bezoar formation in the duodenum of a child with a grossly dilated, dysmotile duodenum following surgery for jejunal atresia. The presenting symptoms were vomiting, diarrhoea, and growth failure, with evidence of malabsorption secondary to bacterial overgrowth in the bezoar. Plication of the duodenum to reduce its size and improve its motility may reduce the likelihood of future bezoar formation.

Bezoars↗
PubMedDate not supplied

Bezoar manifested with digestive and biliary obstruction.

BACKGROUND/AIMS: Gastrointestinal obstructions caused by bezoars are uncommon but are encountered with increasing frequency in general surgery. METHODOLOGY: We made a retrospective review of 30 cases treated in the National Cheng Kung University hospital between July 1988 and December 1994. RESULTS: Fourteen patients had either prior gastric surgery (9) or peptic ulcer disease (5) and were categorized as group I. The remaining 16 patients without above conditions were categorized as group II; and seven of them had history of ingestion of Pho Pu Zi (Cordia dichotoma Frost. f.), three had food bolus ingestion, two had diverticulum, two had adhesion and the remaining two had no significant features. Two patients, who received endoscopic removal of gastric bezoar and subsequently developed bowel obstruction, needed operation. Sixteen of 30 who underwent operation within 24 hours after arrival, recuperated uneventfully and most were discharged within a week. Eleven patients who received operation after 24 hours resulted in prolonged hospitalization in 9 and death in two. Re-operation was performed in one case for the recurrence of obstruction by the residual bezoar. CONCLUSION: Dietary factors (Pho Pu Zi or bolus ingestion), and gastrointestinal (GI) anatomical lesion (diverticulum or adhesion) are the profound etiologies for formation of bezoars in cases without previous gastric surgery. On the other hand, gastric factors (previous ulcer surgery or peptic ulcer) play a major role even after ingestion of nonspecific high fiber diet. Early diagnosis, surgical intervention without delay and thorough exploration of the entire GI tract are essential for good postoperative results.

Adolescent↗
PubMed2001

Mitochondrial DNA reveal that domestic goat (Capra hircus) are genetically affected by two subspecies of bezoar (Capra aegagurus).

This article describes the complete sequences of the mitochondrial DNA displacement loop (D-loop) region and cytochrome b gene from domestic goats in Laos (Laos native) and wild goat "markhor" (C. falconeri). The wild goat "bezoar" (Capra aegagrus) has been considered to be the strongest candidate for the ancestor of the domestic goats (C. hircus); however, there is not sufficient molecular data to verify the hypothesis at present. In phylogenetic analyses, two wild goats, the markhor and the ibex (C. ibex), appeared as an outgroup, while the bezoar was located in a cluster of domestic goats. Mitochondrial haplotypes of Laos natives revealed two distinct major clusters: one was the same as the bezoar, the second, unique to Laos natives. The topology and calibrated levels of sequence divergence suggests that these clusters might represent at least two different subspecies of ancestral bezoars.

Animals↗
PubMed2005

Inhibitory effects of bezoar bovis on intimal formation and vascular smooth muscle cell proliferation in rat.

Intimal formation of animal carotid arteries induced by balloon endothelial denudation has been considered to be an "accelerated atherosclerosis" model and used in primary screening methods to evaluate natural drugs and chemical candidates. The aim of the present study was to examine whether intimal formation is prevented by Bezoar Bovis (dried cattle gallbladder stones: Niuhuang in Chinese and Go-o in Japanese), which has been used to prevent heart palpitation in patients with hypertension. The intimal-to-medial area ratio in rat carotid arteries 7 days after balloon endothelial denudation was significantly reduced by oral administration of Bezoar Bovis. Bezoar Bovis also suppressed vascular smooth muscle cells (VSMCs) proliferation, which is thought to play important roles in the intimal formation after endothelial damage and also atherosclerosis resulting from long-term inappropriate lifestyle. The present findings suggest that Bezoar Bovis may be useful for preventing atherosclerosis and for protection against restenosis after percutaneous coronary intervention, for which effective reduction method is not currently available.

Animals↗
PubMed1997

Bezoar formation and malabsorption secondary to persistent dilatation and dysmotility of the duodenum after repair of proximal jejunal atresia

Bezoar formation is a rare but well-recognised complication of previous gastric surgery and persimmon ingestion. We present a case of bezoar formation in the duodenum of a child with a grossly dilated, dysmotile duodenum following surgery for jejunal atresia. The presenting symptoms were vomiting, diarrhoea, and growth failure, with evidence of malabsorption secondary to bacterial overgrowth in the bezoar. Plication of the duodenum to reduce its size and improve its motility may reduce the likelihood of future bezoar formation.

Journal Article↗
PubMed1995

Colonic medication bezoar from extended-release nifedipine and procainamide.

We report an unusual case of a primary colonic bezoar composed of extended-release formulations of nifedipine and procainamide. Although these bezoars are rare, the increasingly frequent application of extended-release delivery systems to other commonly prescribed medications may increase the incidence of such bezoars in vulnerable patients. Clinicians should be aware of this potential problem when prescribing these medications, and have a high index of suspicion when painful or refractory constipation occurs.

Aged↗
PubMed1996

Gastric bezoar following penetrating abdominal injury. Diagnosis and endoscopic therapy.

We present a patient who developed a gastric bezoar following extensive penetrating abdominal trauma. Bezoar pathogenesis, diagnosis, and endoscopic therapy are highlighted. Additionally, alternative therapeutic modalities are explored with a review of the literature. Combination endoscopic lavage fragmentation/extraction presents a safe method of bezoar resolution.

Abdominal Injuries↗
PubMedDate not supplied

Gummi bear bezoar: a case report.

Bezoars in children are rare. Bezoars causing intestinal obstruction are even more unusual. We would like to report the first Gummi Bear Bezoar causing a large bowel obstruction in a child.

Bezoars↗
PubMed2006

Rapunzel's syndrome: gastric bezoars and endoscopic management.

The diagnosis of bezoar formation may be difficult secondary to the nonspecific clinical presentation. Once a diagnosis is reached, the clinician has many options for management. These management options are largely based on the size and composition of the bezoar along with the experience or preference of the operator. Once a bezoar has been safely treated, steps should be taken to avoid recurrence, because many patients may be at risk for reformation.

Bezoars↗
PubMed2004

Use of a mechanical thrombectomy catheter for percutaneous extraction of renal fungal bezoars in a premature infant.

Fungal urinary tract infections are commonly encountered in the hospitalized neonate. Although these infections most commonly take the form of cystitis, the infection may be complicated by the formation of fungal bezoars, with subsequent urinary tract obstruction. In certain cases, endosurgical debulking or extraction of the fungal bezoar may be necessary. This is particularly challenging in neonates due to their often-compromised physiologic state and small size. We report a case of a premature infant with bilateral obstructing renal fungal bezoars in whom a percutaneous catheter-based thrombectomy system was used successfully to debulk the fungal burden.

Amphotericin B↗
PubMed1999

Bezoars in the stomach and small bowel--CT appearance.

AIM: The aim of this study was to present the computed tomography (CT) appearance of trichobezoars, phytobezoars and other unusual ingested material. MATERIALS AND METHODS: Seven patients diagnosed on CT with bezoars in the stomach or small intestine were reviewed with special attention on the characteristics of the intraluminal mass and the presence of proximal dilatation. RESULTS: There were six women and one man aged 14-81 years. CT was performed because of abdominal pain and a palpable abdominal mass. In none of the cases was the diagnosis suspected clinically. Four patients had a trichobezoar occupying the entire lumen of the stomach. It appeared as a concentric inhomogeneous mass with entrapped air, surrounded by contrast material. In the other three patients the bezoar was confined to the small intestine and was composed respectively of vegetable fibres, ingested toilet paper and an olive stone. The first two had a mottled appearance whereas the last one was small, spherical and well defined. Variable proximal dilatation of the small bowel was present in all three. CONCLUSION: With the increased use of CT in the evaluation of patients with non-specific abdominal pain, it is important to recognize the CT appearance of bezoars, as this diagnosis is often not suspected clinically.

Adolescent↗
PubMed2001

[Esophageal bezoar resulting from nasogastric enteral feeding in an intensive care unit].

We report two cases of oesophageal bezoar in patients given enteral nutrition by nasogastric tubing in an intensive care unit. These two complications occurred during the year following the replacement of our standard enteral feed by a new preparation enriched in proteins. In both patients, the bezoar could be endoscopically removed. The enteral feeding solution is likely to be responsible for the development of this complication because no other factor known to favour this complication such as concomitant administration of sulfacrate or anti-acid agents was given to the patients; and the bezoar developed shortly after the new enteral feeding solution was used, a hypothesis supported by several similar case reports in the medical literature.

Aged↗
PubMed1983

Obstructive syndrome due to a bezoar in a B-II gastric stump. Endoscopic treatment.

Three cases of a phytobezoar in B-II-gastrectomy are considered in relation to their development around a suture thread acting as precipitating factor; the bezoar was responsible for the presenting obstructive syndrome. Endoscopic diagnosis and definitive treatment by removal of the bezoar together with the thread after cutting the fixed end is stressed. Various kinds of treatment proposed by other authors for the common types of bezoar are discussed.

Aged↗
PubMed1995

Urinary fungal bezoars in children--report of two cases.

We report two cases of urinary obstruction by fungal bezoars in full-term neonates who presented a uropathy detected antenatally. Early percutaneous urinary diversion was performed to relieve renal impairment secondary to a primary megaureter in the first case and to bilateral pelvi-ureteral obstruction in the second. Acute fungal obstruction occurred first on the side of the primary megaureter and then on the healthy side in the first patient. Symptoms of infection and impaired renal function led to a diagnosis of fungal bezoar. In the second patient the development of the bezoar was more insidious and occurred after surgical correction of the obstructive pelvi-ureteral junction on the left side. Candiduria was the first sign in both cases. Ultrasonography is the best method to visualize fungal masses within the collecting system. In most cases, percutaneous nephrostomy allows relief of the obstruction, sampling of urine for culture and irrigation with amphotericin B. However, additional surgical intervention may be necessary. Systemic antifungal treatment using mainly 5-flucytosine is also given.

Amphotericin B↗
PubMed1993

"Postgastrectomy" bezoar secondary to gastric cancer.

Phytobezoars are frequently associated with partial gastrectomy and are generally considered benign. However, we report two patients who developed a gastric bezoar due to malignancy at the anastomotic site. Development of intragastric bezoar may be an indication of neoplastic growth sufficient to obstruct a small gastric outlet. Consequently, we conclude that endoscopic or surgical evaluation of the anastomotic site is necessary in patients who develop bezoars after gastric surgery.

Adult↗
PubMed1993

Pathogenetic aspects of persimmon bezoars. A case-control retrospective study.

To prove that ingestion of unpeeled persimmon is necessary for the development of a persimmon phytobezoar, we interviewed 15 patients, in most of whom this condition developed after peptic ulcer surgery. We compared the study group with a control group of 15 patients who had undergone peptic ulcer surgery but did not have a bezoar. In contrast with the control group, most patients with bezoars had ingested unpeeled fruits (p < 0.01). While ingestion of persimmon carried a 9.8-fold risk of bezoar development, ingestion of the unpeeled fruit increased the risk of this complication 56 times over that of age- and sex-matched controls. We recommend that patients who have undergone ulcer surgery be warned particularly against eating unpeeled persimmons.

Bezoars↗
PubMedDate not supplied

Extended-release nifedipine bezoar identified one year after discontinuation.

OBJECTIVE: To report a case of tablet impaction of nifedipine extended-release tablets (Procardia XL) discovered one year after discontinuation of the drug in a patient with peptic stricture. DATA SOURCES: English-language references identified via a MEDLINE search from 1966 through September 1998 and bibliographic review of pertinent articles. DATA SYNTHESIS: Extended-release nifedipine has been associated with the formation of medication bezoars in case reports. Bezoars are concretions of undigested material within the gastrointestinal (GI) tract. Although they can occur throughout the GI tract, bezoars are most frequently located in the stomach and, rarely, in the duodenum. We report an unusual case of tablet impaction with a gastric outlet obstruction in the duodenal area discovered one year after the patient stopped taking extended-release nifedipine. CONCLUSIONS: Extended-release nifedipine is associated with tablet impaction, even long after discontinuing administration. Although rare, clinicians should be aware of this potential problem when prescribing extended-release medications to patients at risk, and should consider this possible etiology when refractory epigastric pain and weight loss occur.

Aged↗