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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

A 10 cm conical phytobezoar was found 20 cm distal to the gastrojejunostomy. It was removed by an enterotomy.
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Figure 3: A 10 cm conical phytobezoar was found 20 cm distal to the gastrojejunostomy. It was removed by an enterotomy.

Mentions: The patient provided consent for expedited laparotomy and relief of obstruction. Intra-operatively, the jejunum was found to be dilated from the duodenojejunal flexure to a large bolus obstruction. A conical mass suspicious of a bezoar was found measuring 10 cm in length, situated 20 cm beyond the gastrojejunostomy. The small bowel distal to this site was collapsed. Attempts to break up this hard bolus mass externally were unsuccessful. The bezoar eventually had to be removed in whole via an enterotomy. Careful examination confirmed that it was indeed a phytobezoar (Figure 3).


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)

A 10 cm conical phytobezoar was found 20 cm distal to the gastrojejunostomy. It was removed by an enterotomy.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: A 10 cm conical phytobezoar was found 20 cm distal to the gastrojejunostomy. It was removed by an enterotomy.
Mentions: The patient provided consent for expedited laparotomy and relief of obstruction. Intra-operatively, the jejunum was found to be dilated from the duodenojejunal flexure to a large bolus obstruction. A conical mass suspicious of a bezoar was found measuring 10 cm in length, situated 20 cm beyond the gastrojejunostomy. The small bowel distal to this site was collapsed. Attempts to break up this hard bolus mass externally were unsuccessful. The bezoar eventually had to be removed in whole via an enterotomy. Careful examination confirmed that it was indeed a phytobezoar (Figure 3).

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