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Bezoar


 

         Collections of indigestible material found in the gastrointestinal tract, usually the stomach

o       From the Persian word padzahr which means antidote since they were once used for this purpose

         Incidence is very low

         Risk of trichobezoar (eating of hair) is greater among mentally retarded or emotionally disturbed children

o       Also occurs as an occupational disease in brushmakers, blanket weavers and wool workers

         Much more common in females (90%) aged 10 to 19

         Etiology

o       Chewing on or eating hair or fuzzy materials or indigestible vegetable fiber

o       Material unable to exit stomach because of large size

o       Gastric outlet obstruction may play a roll

o       Poor gastric motility such as might occur in diabetics

         Predisposition

o       Previous gastric surgery such as vagotomy, pyloroplasty, antrectomy or partial gastrectomy

o       Inadequate chewing of food

         Missing teeth, dentures

o       Massive overindulgence of food with high fiber contents such as dates or persimmons

         Clinical symptoms

o       Anorexia

o       Bloating

o       Early satiety

o       History of trichophagy eating hair

o       Trichoptysis hair may be coughed up

o       May be asymptomatic

         Phytobezoar (55% of all bezoars):

o       Poorly digested vegetable fibers such as

         Skin and seeds of fruits and vegetables

         Oranges

         Persimmons

o       Most common

o       Unripe persimmons contain a chemical shibuol that forms a glue-like coagulum after contact with dilute acid in the stomach

o       May become impacted in small bowel after forming in stomach

         Trichobezoar (hair)

o       80% are < age 30, almost exclusively in females

o       Associated with gastric ulcer in 24-70%

         Radiographic findings

o       Upper part of a large bezoar may be visible as a mass with a convex upper border projecting into the gastric air bubble

o       An erect abdominal radiograph and a supine radiograph may show a prominent gastric outline with an intragastric mottled mass, outlined by gas in the distended stomach, mimicking a food-filled stomach

o       On barium studies, they produce an intraluminal filling defect without attachment to bowel wall

o       Interstices of bezoar are filled with barium

 

A trichobezoar in a mentally disturbed 14 year-old girl who was eating her own hair.
Note the large filling defect occupying most of the stomach
with barium mixed in within the interstices of the mass.
A delayed film would show the barium remaining in the bezoar while exiting the rest of the stomach

 

 

o       Barium remains in bezoar for hours after exiting remainder of bowel

         Get delayed film if bezoar is suspected

o       Partial or  complete bowel obstruction

o       CT

         Mobile intragastric mass consisting of "compressed concentric rings"

         A mixed density pattern due to the presence of entrapped air and food debris

         Complications

o       Pressure necrosis of bowel wall may lead to perforation, peritonitis

o       Distal extension of the bezoar can lead to

         Obstructive jaundice

         Acute pancreatitis

         Protein-losing enteropathy

         Steatorrhea

         Mechanical small bowel obstruction alone or with perforation

         DDx

o       Lobulated, villous adenoma

o       Leiomyosarcoma

 

For a photo of a trichobezoar (not the one in the patient on this page), go to the following link at the National Museum of Health and Medicine: http://nmhm.washingtondc.museum/explore/anatifacts/4_trich.html

Gastric Trichobezoar  - Narinder K Kaushik, Yash P Sharma, Asha Negi, Amal Jaswal: Ind J Radiol Imag 1999; 9 : 3 : 137-139