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Park, Lee, Jeong, Lee, Moon, Park, and Shin: The Clinical Analysis of 12 Cases of Bezoars
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2009; 77(3): 177-183.

Published online: 4 September 2009

DOI: https://doi.org/10.4174/jkss.2009.77.3.177

The Clinical Analysis of 12 Cases of Bezoars

Jong Seob Park, M.D., Jong In Lee, M.D., Jin Ho Jeong, M.D., Jong Hoon Lee, M.D., Hyoun Jong Moon, M.D., Jea Kun Park, M.D., Hyuk Jae Shin, M.D.

Department of Surgery, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea.

Corresponding author (gslji@hanmail.net)

Received 1 June 2009       Accepted 26 June 2009

Copyright © 2009 The Korean Surgical Society

Abstract

Purpose

Bezoars are the uncommon result of ingestion of poorly digestible or indigestible substances. It is defined as retained concretions of animal or vegetable material in the gastrointestinal tract. The aim of this study was to review and analyze in these cases with reviewing literature.

Methods

The medical records of 12 cases, treated between May 1999 and April 2009, were reviewed. The clinical characteristics, as well as the diagnostic evaluations and results of medical and surgical treatment, were also analyzed retrospectively.

Results

Of the 12 cases, 6 men and 6 women, the bezoars were in the stomach, jejunum and ileum or in both stomach and jejunum in 1, 2, 7 and 2 cases, respectively. 4 patients (33.3%) had a history of gastric or duodenal ulcer following previously received gastric surgery such as subtotal gastrectomy or truncal vagotomy with pyloroplasty. In 3 cases, the bezoars were found in operative field under the impression of intestinal obstruction due to adhesive ileus, which could not be found by preoperative radiologic evaluation. Among the 12 cases, 11 cases were successfully treated by operative and endoscopic removal, but 1 case expired due to sepsis.

Conclusion

A bezoar occurs mainly in patients who have previously undergone a gastric operation. Surgeons should keep in mind the possibility of bezoars in patients presenting an intestinal obstruction following a past gastric operation. The principle of treatment for bezoars used to be surgery, but recently gastric bezoars are often treated by gastrofiberscopy.

Keywords: Bezoar, Intestinal obstruction, Acute abdomen

Figures and Tables

Fig. 1
Monthly incidence of bezoars.
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Fig. 2
The computed tomogram and operative finding of jejunal bezoar with SMA syndrome. (A) The arrow shows conglomerated jejunal phytobezoa. (B) Compressed duodenum with passage disturbance of gastrograffin by SMA. The arrow shows SMA. (C) The bezoar was removed via duodenojejunostomy.
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Fig. 3
The obstructive ileal phytobezoar (A) which could not be found in preoperative evaluation was identified after laparotomy extracted bezoar (B) via ileotomy.
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Table 1
Clinical features of the patients; past history and previous operation
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Table 2
Clinical manifestation
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Table 3
Modes of surgical management and its location of bezoars
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*Cases of multiple bezoar; †Including two cases of multiple bezoar.

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