Fact-sheet: Bezoard
Updated on 04/16/2018 at 10:26 AM
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Definition
Concretion of non-digestible content in the gastrointestinal tract: .Phytobezoar: most common, gastric motility, vegetarian .Trichobezoar: psychiatric context .Pharmacobezoar: medications (resin: Kayexalate) .Lactobezoar: newborn - first week. Predisposing factors: .Gastric surgery, vagotomy, gastroparesis .Vegetarian diet, fiber (persimmons, plums) .Trichotillomania .Psychiatric history Obstructive pathophysiology: Concretion initially intragastric Partial or complete migration into small bowel Small bowel impaction (50 cm from ileocecal valve) Mechanical small bowel obstructive syndrome – endoluminal 17-25% of cases Incidence: Approximately 5/1000 Rapunzel syndrome: Extension of the intragastric bezoar Duodenal loop, jejunum
CT
Endoluminal mechanical small bowel obstruction:
.Well-defined ovoid mass
.Lesion capsule
.Trapped air
.Mixed pseudo-fat density ("Fat density floating fibers")
.Mechanical small bowel obstructive syndrome, classically with impaction at approximately 50 cm from the ileocecal valve, where the caliber is smallest.
.Similar floating debris in upstream small bowel loops
.Intragastric concretion
Management
Management: >Surveillance >Surgical: Laparotomy/Laparoscopy .Manual fragmentation, manual progression into the cecum .Enterotomy if not feasible +/- segmental small bowel resection – compromised bowel Multiple locations in 30% of cases >+/-Gastrostomy for gastric evacuation