Gastric Bezoar

• • 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

Epidemiology

• • 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

Symptoms and Signs

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

  • Gastric perforation

  • Abdominal pain

Laboratory Findings

• • Anemia

Imaging Findings

• • 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

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

Rule Out

• • Other causes of GI bleeding or perforation

• • Diagnosis is usually apparent on upper GI contrast radiographic

  • Upper GI endoscopy is both diagnostic and therapeutic

When to Admit

• • Severe GI bleeding

  • Gastric perforation

  • High-grade obstruction

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

Surgery

Indications

• • Inability to extract endoscopically

  • Complications of gastric bleeding or perforation

Complications

• • Gastric ulceration with bleeding and perforation

Prognosis

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

References