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Bezoar



General Considerations

  • Collections of indigestible material found in the gastrointestinal tract, usually the stomach
    • 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 challenged or emotionally disturbed children
    • Also occurs as an occupational disease in brushmakers, blanket weavers and wool workers
  • Much more common in females (90%) aged 10 to 19

Etiology

  • Chewing on or eating hair or fuzzy materials or indigestible vegetable fiber
  • Material unable to exit stomach because of large size
  • Gastric outlet obstruction may play a roll
  • Poor gastric motility such as might occur in diabetics also may contribute

Predisposition

  • Previous gastric surgery such as vagotomy, pyloroplasty, antrectomy or partial gastrectomy
  • Inadequate chewing of food
    • Missing teeth, dentures
  • Massive overindulgence of food with high fiber contents such as dates or persimmons

Clinical symptoms

  • Anorexia
  • Bloating
  • Early satiety
  • History of trichophagy – eating hair
  • Trichoptysis – hair may be coughed up
  • May be asymptomatic

Phytobezoar (55% of all bezoars):

  • Poorly digested vegetable fibers such as
    • Skin and seeds of fruits and vegetables
      • Oranges
      • Persimmons
        • Most common
        • Unripe persimmons contain a chemical “shibuol” that forms a gluelike coagulum after contact with dilute acid in the stomach
  • May become impacted in small bowel after forming in stomach

Trichobezoar (hair)

  • 80% are < age 30, almost exclusively in females
  • Associated with gastric ulcer in 24-70%

Imaging findings

  • Upper part of a large bezoar may be visible as a mass with a convex upper border projecting into the gastric air bubble
  • 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
  • On barium studies, they produce an intraluminal filling defect without attachment to bowel wall
  • Interstices of bezoar are filled with barium
  • Barium remains in bezoar for hours after exiting remainder of bowel
    • Get delayed film if bezoar is suspected
  • Partial or  complete bowel obstruction
  • CT
    • Mobile intragastric mass consisting of "compressed concentric rings"
    • A mixed density pattern due to the presence of entrapped air and food debris

Complications

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

  • Lobulated, villous adenoma
  • Leiomyosarcoma

 

bezoar

Bezoar. A huge filling defect with barium intermixed in its interstices is seen in the dilated stomach of this patient with a bezoar(blue arrow). The image is from an upper gastrointestinal series.
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Gastric Trichobezoar  - Narinder K Kaushik, Yash P Sharma, Asha Negi, Amal Jaswal: Ind J Radiol Imag 1999; 9 : 3 : 137-139