Upper Gastrointestinal Manifestation of Bezoars and the Etiological Factors: A Literature Review

Table 3

A summary table with case studies regarding gastric bezoars.

Case no. A/G; [ref no.]	History/previous operation	Symptoms	Clinical findings	Locations of bezoar in the stomach	Size of bezoar (cm)	Associated gastric lesions	Composition of the bezoar	Management	Complications
(1) 49/M [1]	Habitual jujubes ingestion	Epigastric pain; Nausea and vomiting; Gastric reflux	Anemic; Abdominal tenderness	Body		Necrotic ulcer	Jujubes (diospyrobezoar)	Coca-Cola; Lithotripsy	None
(2) 18/F [2]	Trichophagia (Rapunzel syndrome)	Acute abdominal pain; Vomiting	Weight loss	Full-length	120 cm	Ulcer	Hair (trichobezoar)	Laparotomy	Gastric perforation
(3) 47/M [3]	6-month	Epigastric pain	Weight loss	Body		None	Phloem fibers; Raw stinging nettle (phytobezoar)	Laparotomy	None
(4) 76/M [4]	Arterial hypertension	Dyspepsia; Epigastric pain	None	Body	10 cm	Ulcer	Vegetable fibers (phytobezoar)	Endoscopic (polypectomy snare)	None
(5) M [46]	None	Abdominal pain; Early satiety	Weight loss	Body	N/A	None	Fatty acids and lecithin (phytobezoar)	Surgical removal	None
(6) 96 cases; [7]	Prematurity; Low birth weight	Abdominal distension; Vomiting; Diarrhea	Palpable abdominal mass	N/A	N/A	None	High casein content 54.2%, medium chain triglycerides 54.2%; Caloric density 65.6% (lactobezoars)	Cessation of oral feedings administration of intravenous fluids; Gastric lavage surgery	Perforations (7 patients)
(7) 44/F [9]	Anxiety disorder	Semiconscious; Fast breathing	Potassium overdose (hyperkalemia); Bp-89/59 mmHg; Pulse 82/min, resp. 20/min	Gastric fundus	N/A	None	Extended-release potassium chloride (pharmacobezoar)	Whole bowel irrigation using polyethylene glycol (NG tube); Upper GI endoscopic removal of pharmacobezoar	None
(8) 60/F [47]	Open cholecystectomy and choledicholithotomy	Epigastric pain; Vomiting	Mildly anemic; Dehydrated; Tachycardia; Epigastric tenderness	Pyloric canal	N/A	None	Aluminum hydroxide tablets (pharmacobezoar)	Endoscopic removal using biopsy forceps and Dormia basket	None
(9) 58/M [48]	3-month; Suspected Crohn’s disease	Abdominal pain; Vomiting	Circumferential wall thickening of pylorus	Pylorus	N/A	Gastritis noncaseating epithelioid; Multiple hyperplastic polyps	Mesalamine pills (pharmacobezoar)	Laparoscopic gastrojejunostomy	Gastric outlet obstruction
(10) 54/M [10]	Primary lung cancer (metastatic); Mechanically ventilated	Hyperkalemia	Constrictive effusive metastatic pericarditis kidney failure	Body		None	Sodium polystyrene sulfonate (pharmacobezoar)	Postmortem	Expired
(11) 7/M [11]	Pica	Abdominal pain; Vomiting	Abdominal tenderness guarding	Full-length gastric bezoar		None	Wooden bezoar	Laparoscopic; Psychiatric evaluation	Gastric perforation
(12) 53/F [49]	Pica; (anxiety, depression); Roux-en-Y gastric bypass	Severe personality disorders; Vomiting; Constipation	Mild abdominal distention	N/A		None	Cardboard and newspaper	Endoscopic removal; Psychiatric evaluation	None
(13) M/F [13]	Denture wearers; Impaired mastication (8 male/6 female)	Not mentioned	Muscle bursts were longer = lower muscle work; Muscle burst decreased significantly for denture wearers; Longer chewing duration; Food boli were less disorganized	N/A	N/A	N/A	Chewing of paraffin and meat	N/A	Impaired chewing in complete denture wearers modifies the dynamics of meat bezoar formation due to large fragmented bolus
(14) 44/F [14]	Irritable bowel syndrome; Consumption of large quantities of honeycomb for health benefits	Epigastric pain; Nausea	None	Body	N/A	N/A	Honeycomb	Endoscopic removal; 100 ml of hydrogen peroxide; Modified and conventional needle-knife; Snares and baskets	None
(15) 69/F [12]	Cholelithiasis; Choledocholithiasis	Right-sided upper abdominal pain; Nausea and vomiting	Multiple biliary stones in the common bile duct	Pylorus and duodenal bulb	N/A	N/A	Gallstones and indigestible material	Proton pump inhibitor and cola drink	None
(16) 14/F [17]	Anorexia nervosa; Thalassemia trait and growth hormone replacement.; Trichotillomania	Nausea and vomiting	Weight loss; Nontender, large, firm, left upper quadrant mass	Full-length; (entire stomach and duodenum)	N/A	None	Hair (trichobezoar)	Laparotomy	None
(17) 45/F [15]	Habitual consumption of cows’ feet stew with hair and skin intact.; Previous history of gastric bezoar via laparotomy	Dysphagia; Abdominal distension; Abdominal pain; Shortness of breath; Generalized weakness	Microcytic anemia; Malnourished	Lesser curvature	2.42 kg	Ulcer at the lesser curvature	Mass of hair; Leathery skin and altered food (trichobezoar)	Laparotomy; Gastrotomy	None
(18) 19/F [16]	Anorexia nervosa; Binge-purge; Hematemesis	Nausea and vomiting; Constipation	Weight loss; Parotid hypertrophy bilaterally	Vomited a cylindrical bezoar from the stomach	4 cm	Possible erosions or ulcer	Debris and birefringent; Foreign material; Vegetable matter	Conservative treatment	N/A
(19) 21/F [18]	Bulimia nervosa; Binge eating episodes	Abdominal pain; Nausea; Retching	Afebrile, normotensive with mild tachycardia; Distended abdomen; Weight loss	Greater curvature overlying the pylorus		None	Food matter	Coca-Cola; Metoclopramide; Endoscopic; Psychotherapy	None
(20) 3/F [19]	Sickle cell disease	Upper abdominal pain; Nonbilious emesis; Anorexia	Large intra-abdominal mass epigastric tenderness; Hemoglobin 9.6 g/dL; Leukocyte Polymorphonuclear leukocyte 69%; Platelet 254,000/μL	Stomach extended to the duodenum		N/A	Trichobezoar	Laparotomy; Gastrotomy	None
(21) 62/F [51]	Multiple myeloma	Epigastric pain; Vomiting; Weight loss; Fatigue	Elevated IgG of 49.2 g/L; Low IgM and IgA levels IgG; Lambda paraprotein 35 g/L; Lambda Bence-Jones protein in the urine, elevated β2-microglobulin 5.50 mg/mL	Body extended pylorus	N/A	Mild focal intestinal metaplasia and glandular atrophy	Phytobezoar	Coca-Cola pancreatic enzyme supplementation	Expired in 1 month
(22) 42/F [39]	Hypertension; Type 2 diabetes mellitus; Peripheral neuropathy; Gastroparesis	Nausea and vomiting; Abdominal pain; Fever	Obese, epigastric tenderness; Significant distress; Abdominal distension; Hypoactive bowel sounds	Antrum		N/A	Cholesterol gallstone induced bezoar	Laparotomy; Gastrotomy	None
(23) 34/F [42]	Laparoscopic adjustable gastric banding	Epigastric fullness; Nausea and vomiting	Obese; BMI 37 kg/m2	In eccentric pouch dilatation	N/A	N/A	Bezoar	Liquid diet; Laparoscopy	Anterolateral slippage of the band
(24) 48/M [43]	Laparoscopic adjustable gastric banding	Dysphagia	N/A	Body	N/A	Erosions	Phytobezoar	Papain (1 week)	None
(25) 70/M [54]	Cholecystogastric fistula	Painful lump in the right hypochondriac region with fever and anorexia	CT revealed fistula between the gallbladder and gastric antrum.	Antrum		Fistulous opening in the prepyloric region	Gallstone bezoar; (cholesterol and calcium oxalate)	Laparotomy	None
(26) 63/F [56]	Roux-en-Y gastric bypass	Abdominal distention; Nausea and vomiting	Morbid obese (body mass index 49.5 kg/m^2); 14 months postsurgery BMI 28 kg/m^2	Gastric pouch	5 cm	None	Persimmon; Vegetables	Endoscopic; Biopsy snare	None
(27) 65/M [58]	Chestnuts consumption	Abdominal pain	Abdominal CT indicated gastric perforation	Lesser curvature	N/A	Ulcer	Tannin; Chestnut bezoars	Surgery; Coca-Cola	Gastric perforation
(28) 73M/58F [59]	(2 cases); (1) Billroth I partial gastrectomy for gastric cancer.; (2) Laparoscopic adjustable gastric banding	N/A	Cancer; Obesity	Proximal gastric pouch	10 cm; 8 cm	N/A	Phytobezoar	200 micron laser fiber and 550 micron laser fiber (Ho:YAG laser)	None
(29) 62/F [61]	Acute gastritis and gallstones	Epigastric pain; Nausea and vomiting; Hiccups; Heartburn; Dark loose stools	Abdominal tenderness; Positive Murphy sign; Hyperactive bowel sounds; Pale tongue; Occult blood in the vomit	Body	N/A	Gastric angle with multiple lesions; Bleeding; Gastric ulcers; Venous aneurysm	Bezoar	Chinese medicine purgative combined with pantoprazole sodium intravenous infusion, 40  mg each time, twice a day for 5 days	None

A/G: age/gender; M: male; F: female; NA: not available; cm: centimeter.