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Bezoar in gastro-jejunostomy presenting with symptoms of gastric outlet obstruction: a case report and review of the literature.

Leung E, Barnes R, Wong L - J Med Case Rep (2008)

Bottom Line: Many bezoars can be removed endoscopically, but some will require operative intervention.Once removed, emphasis must be placed upon prevention of recurrence.Surgeons must learn to recognise and classify bezoars in order to provide the most effective therapy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, University Hospitals Coventry and Warwickshire, Coventry, UK. ed.leung@doctors.org.uk

ABSTRACT

Introduction: Gastric outlet obstruction usually presents with non-bilious vomiting, colicky epigastric pain, loss of appetite and occasionally, upper gastrointestinal bleeding. Causes can be classified as benign or malignant, or as extra- or intraluminal. Gastrojejunostomy is a well-recognised surgical procedure performed to bypass gastric outlet obstruction. A bezoar occurs most commonly in patients with impaired gastrointestinal motility or with a history of gastric surgery. It is an intestinal concretion, which fails to pass along the alimentary canal.

Case presentation: A 62-year-old Asian woman with a history of gastrojejunostomy for peptic ulcer disease was admitted to hospital with epigastric pain, vomiting and dehydration. All investigations concluded gastric outlet obstruction secondary to a "stricture" at the site of gastrojejunostomy. Subsequent laparotomy revealed that the cause of the obstruction was a bezoar.

Conclusion: Many bezoars can be removed endoscopically, but some will require operative intervention. Once removed, emphasis must be placed upon prevention of recurrence. Surgeons must learn to recognise and classify bezoars in order to provide the most effective therapy.

No MeSH data available.


Related in: MedlinePlus

Image taken during upper endoscopy. a) Oedema present at the anastomotic site of the gastrojejunostomy. b) No evidence of obstruction beyond the anastomosis.
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Figure 1: Image taken during upper endoscopy. a) Oedema present at the anastomotic site of the gastrojejunostomy. b) No evidence of obstruction beyond the anastomosis.

Mentions: This woman had a history of peptic ulcer disease over 20 years ago in Kenya. It had led to GOO requiring truncal vagotomy and gastrojejunostomy. In order to investigate the cause of her dysphagia and loss of appetite, she had undergone an upper gastrointestinal endoscopy 3 weeks before this admission. This showed inflammation and oedema at the anastomotic site of the gastrojejunostomy, but no evidence of obstruction or stricture (Figure 1). She was then prescribed daily omeprazole, which was the only medication she was taking on admission.


Bezoar in gastro-jejunostomy presenting with symptoms of gastric outlet obstruction: a case report and review of the literature.

Leung E, Barnes R, Wong L - J Med Case Rep (2008)

Image taken during upper endoscopy. a) Oedema present at the anastomotic site of the gastrojejunostomy. b) No evidence of obstruction beyond the anastomosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2567335&req=5

Figure 1: Image taken during upper endoscopy. a) Oedema present at the anastomotic site of the gastrojejunostomy. b) No evidence of obstruction beyond the anastomosis.
Mentions: This woman had a history of peptic ulcer disease over 20 years ago in Kenya. It had led to GOO requiring truncal vagotomy and gastrojejunostomy. In order to investigate the cause of her dysphagia and loss of appetite, she had undergone an upper gastrointestinal endoscopy 3 weeks before this admission. This showed inflammation and oedema at the anastomotic site of the gastrojejunostomy, but no evidence of obstruction or stricture (Figure 1). She was then prescribed daily omeprazole, which was the only medication she was taking on admission.

Bottom Line: Many bezoars can be removed endoscopically, but some will require operative intervention.Once removed, emphasis must be placed upon prevention of recurrence.Surgeons must learn to recognise and classify bezoars in order to provide the most effective therapy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, University Hospitals Coventry and Warwickshire, Coventry, UK. ed.leung@doctors.org.uk

ABSTRACT

Introduction: Gastric outlet obstruction usually presents with non-bilious vomiting, colicky epigastric pain, loss of appetite and occasionally, upper gastrointestinal bleeding. Causes can be classified as benign or malignant, or as extra- or intraluminal. Gastrojejunostomy is a well-recognised surgical procedure performed to bypass gastric outlet obstruction. A bezoar occurs most commonly in patients with impaired gastrointestinal motility or with a history of gastric surgery. It is an intestinal concretion, which fails to pass along the alimentary canal.

Case presentation: A 62-year-old Asian woman with a history of gastrojejunostomy for peptic ulcer disease was admitted to hospital with epigastric pain, vomiting and dehydration. All investigations concluded gastric outlet obstruction secondary to a "stricture" at the site of gastrojejunostomy. Subsequent laparotomy revealed that the cause of the obstruction was a bezoar.

Conclusion: Many bezoars can be removed endoscopically, but some will require operative intervention. Once removed, emphasis must be placed upon prevention of recurrence. Surgeons must learn to recognise and classify bezoars in order to provide the most effective therapy.

No MeSH data available.


Related in: MedlinePlus