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  • • Concretions formed in the stomach, composed of hair or vegetable or fruit fibers, which may cause ulceration of the gastric mucosa with bleeding and perforation

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Epidemiology

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  • Trichobezoars are composed of hair and are usually found in young girls who pick at their hair and swallow it

    Phytobezoars consist of agglomerated vegetable fibers, orange segments or other fruits that contain a large amount of cellulose

    • The postgastrectomy state predisposes to bezoar formation because pepsin and acid secretion are reduced and the triturating function of the antrum is gone

    • Large semisolid bezoars of Candida albicans have also been found in postgastrectomy patients

    • Improper mastication of food is a contributing factor that can sometimes be obviated by providing the patient with properly fitted dentures

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Symptoms and Signs

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  • • Upper GI bleeding from gastric ulcer caused by pressure from mass

    • Gastric perforation

    • Abdominal pain

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Laboratory Findings

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  • • Anemia

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Imaging Findings

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  • • Upper GI contrast radiographic study will show mass in lumen of stomach

    • Upper GI endoscopy will detect the bezoar and usually allow identification of its contents

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  • • Diagnosis is usually apparent on upper GI contrast radiographic study or endoscopy

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Rule Out

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  • • Other causes of GI bleeding or perforation

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  • • Diagnosis is usually apparent on upper GI contrast radiographic

    • Upper GI endoscopy is both diagnostic and therapeutic

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When to Admit

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  • • Severe GI bleeding

    • Gastric perforation

    • High-grade obstruction

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  • • Nearly all gastric bezoars can be broken up and dispersed by endoscopy

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Surgery

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Indications

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  • • Inability to extract endoscopically

    • Complications of gastric bleeding or perforation

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Complications

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  • • Gastric ulceration with bleeding and perforation

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Prognosis

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  • • Ulceration and bleeding are associated with a death rate of 20%

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References

Western C. Bokhari S. Gould S. Rapunzel syndrome: a case report and review. Journal of Gastrointestinal Surgery. 2008, 12(9):1612-4.  [PubMed: 18027058]

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