Features of diagnosis and clinic of giant bezoar

Abstract

Gastrointestinal bezoars are an aggregation of undigested material that can be found in the gastrointestinal tract of humans and some animals. The composition and structure of these formations may be different. The etiology of an intragastric bezoar is multifactorial, including certain risk factors and predisposing factors such as comorbid medical disorders, anatomical abnormalities, and gastric motility disorders that contribute to the development of an intragastric bezoar. There are four types of bezoars: phytobezoars, trichobezoars, pharmacobezoars and lactobesoars. The most common type are phytobezoars, which consist of undigested fiber from vegetables or fruits. Phytobezoar is a bezoar, which is most often based on vegetable fiber. The formation of a phytobezoar in the stomach occurs as a result of eating large amounts of pine nuts, wild pears, and grapes. Separately, dispyrosbezoars are described, they are formed from persimmon, the viscous properties of which lead to the sticking of persimmon parts into a dense mass, followed by the formation of a lump. Most often, phytobezoars are formed in patients who had undergone surgery on the stomach. The article considers a clinical case of removal of a giant bezoar of the stomach stump, which was discovered 19 years after subtotal resection of the stomach because of a malignant neoplasm of the stomach T3N0M0 stage III. The size of the removed phytobezoar was 15 × 9 cm, it was dense, not elastic in consistency, oval in shape. Before removal from the cavity of the stomach stump, the bezoar was easily displaced by palpation of the stomach. On the cross section of the formation there were pieces of undigested plant fibers. According to the histological examination, it was found that the foreign body is represented by fibrous structures with large inclusions containing fiber. The described picture most of all corresponds to the vegetable origin of the bezoar. The remote formation of the stomach stump led to the exhaustion of patient, her body weight was 39 kg with a height of 163 cm, body mass index was 15 kg/m2, the anemia of III severity was diagnosed. The authors of this article remind clinicians of the possibility of the formation of bezoars in the stomach cavity, especially in individuals who consume large amounts of fibrous plant foods, primarily persimmons and oranges.

Keywords

• gastrointestinal tract
• gastric resection
• disopyrobezoar
• phytobezoar
• formation in the stomach cavity