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European Surgery - Acta Chirurgica Austriaca, vol.37, no.4, pp.259-261, 2005 (SCI-Expanded)
Background: Bezoars are concretions of foreign material that become fixed in the stomach and occasionally in the duodenum. They may be of vegetable origin (phytobezoar) or consist of ingested hair (trichobezoar). Treatment options may be endoscopic, enzymatic dissolution or surgical. We present a rare case of intestinal obstruction due to a phytobezoar during enzymatic dissolution treatment. Methods: Case report. Results: A 65-year-old male patient with a history of previous gastric surgery (Billroth I and vagotomy) has been admitted with early satiety, loss of weight, nausea and vomiting. Two bezoars (nearly 8 and 5 cm in diameter) were seen in upper endoscopy. Endoscopic fragmentation and removal could not be undertaken. Enzymatic dissolution treatment with 15 ml N-acetylcysteine in 50 ml saline twice a day was started. On the third day of this treatment, patient was admitted with signs of intestinal obstruction. Computerized tomography confirmed the ileus due to fragmented bezoar in the intestine. The patient was operated on immediately and all the unfragmented bezoar and pieces of fragmented bezoars in the stomach were removed via gastrotomy. Conclusions: Treatment of bezoars depends on the size and composition of the bezoar and the clinical factors that led to its formation. Although each case must be individualized, large trichobezoars, foreign body bezoars, and concretions that are not amenable to dissolution or mechanical disruption are best removed surgically as in our case in order to avoid such rare complications. © Springer-Verlag 2005.