A Bariatric Curveball: A Rare Case of Recurrent Lactobezoars after Roux-en-Y Gastric Bypass Surgery

Abstract

Bariatric surgery is a major risk factor for bezoar formation secondary to decreased gastric motility, gastric acidity, and pyloric function.1 This case is about a 49-year-old female veteran, 3 weeks status-post Roux-en-Y gastric bypass surgery, who presented with acute abdominal pain and oral intolerance. After being diagnosed with a bezoar and esophagogastroduodenoscopic removal, the patient had immediate relief of symptoms. Unfortunately, over the course of 4 months, this patient experienced three recurrent episodes of bezoar formation (with a possible fourth episode that could not be confirmed secondary to resolution of symptoms after administration of oral contrast load). Based on her dietary history and gross appearance of the bezoar, the patient was determined to have developed recurrent lactobezoars. Lactobezoars are composed of milk and mucous proteins and are commonly found in neonates with immature gastrointestinal tracts.7 This unusual complication demonstrates how current dietary recommendations encouraging dairy consumption to meet daily protein requirements may have increased this patient’s risk for lactobezoar formation. This case illustrates the importance of balancing the risks and benefits of macronutrient requirements after bariatric surgery with postsurgical bezoar complications.

Diospyrobezoar Formation in Patient With Sleeve Gastrectomy

“…It is recognized that patients with previous gastric surgeries are predisposed to bezoar formation, most occurring after vagotomy, with incidences ranging from 5 to 12% [2,3]. Furthermore, bezoars have been described in bariatric procedures, such as in patients who have undergone Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric band (LAGB) [4,5]. However, bezoar formation following the laparoscopic sleeve gastrectomy (LSG) procedure has only been described in several case reports to our knowledge [6][7][8][9][10].…”