CASE HISTORY – November 2009

Bezoar in the stomach: case report


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Bezoar is a concrement which most commonly occurs in the stomach. The symptoms are dependent on the size of bezoar and can be listed as follows: abdominal pain, weight loss, anorexia, vomit ing, postprandial fullness. Bezoar may cause a variety of complications, like intestinal obst ruct ion and gastric perforation. Rapunzel syndrome is a condition where  the parent bezoar is in the stomach and a tail of the fi bres or hair extends into the jejunum. Bezoars are classifi ed according to composit ion as phytobezoar from vegetable matter, trichobezoar from hair, lactobezoar from concentrated milk formula and pharmacobezoar from tablets/semi liquid masses of drugs. Ultrasonography, computerized tomography (CT), and  endoscopy may aid diagnosing. Although operative treatment is more commonly used for trichobezoar, phytobezoar can be treated by several methods, including gastric lavage, enzymatic dissolution, endoscopic procedures and video laparoscopic surgery.

The goal of this paper was to give an overview of the essence of bezoar and its clinical expression on the basis of a case report. The case involves a 49-year-old male patient who was hospitalized to Tartu University Hospital in November 2008 because of pain in the left side of the chest and shoulder. The general condition of the patient was satisfactory. There was no fever, cough, vomiting, or anorexia and the patient`s appetite was good. During palpation, faint pain occurred in the upper left side of the stomach. Analyses showed a moderate increase in the CRP (C-reactive protein) and WBC (white blood cell count) indices. The ECG and infarct markers were within norm. The CT scan showed a consolidation area in the basal part of the left lung and a fine streak of pleural effusion. Based  on preliminary investigations, pleuropneumonia was diagnosed. Antibacterial treatment and pain treatment were indicated. As an additional method of investigation, gastroscopy was used. It revealed a large fi rm mass in the stomach. There were 3 ulcers with a size of 2–3 cm in the stomach. Pleuropunction showed exudate. Further decisions regarding treatment were made by doctors` consultation. It was believed that a large bezoar might be located in the stomach, which in turn has caused reactive pleuropneumonia and requires operative treatment. The operation was performed on December 2, 2008; gastrotomy was done and the bezoar was removed. The size of the bezoar was 18 x 12 x 8 cm. The operation and the post-operative period were without peculiarities. Histologically, it was a case of phytobezoar. In the current case report, the patient had a massive bezoar in the stomach, which was the cause of the chest pain. Evidently, the bezoar had a supportive role in the presence of pleural fluid. The cause of the bezoar itself in the current case remained unclear.