Bezoar as a cause of jejunal afferent loop mass after pylorus preserving pancreaticoduodedectomy: A case report

Abstract

Introduction and importance Bezoars may occur in patients after undergoing gastric surgery. Most bezoars are discovered due to small intestine obstruction, causing acute abdomen. Case presentation A 44-year-old woman with a history of intraductal papillary mucinous tumor of the pancreas was initially treated with pylorus-preserving pancreaticoduodenectomy. Two years ago, she had intermittent abdominal pain with no noted abnormality on computed tomography (CT) scan and gastroscopy. During her follow-up, an abdominal CT scan revealed a 1.8-cm low-enhancing nodular tumor with minute central calcification at the afferent loop of the jejunum, later diagnosed as a jejunal tumor. Endoscopy helped determine the location and characteristics of the tumor. Endoscopic findings revealed a bezoar approximately 3 cm below the pancreaticojejunostomy and hepaticojejunostomy, at the end of the afferent loop of the jejunum. Removal using an endoscopic basket failed as the bezoar broke halfway. Residual suture material was found inside the bezoar. Since the size of the bezoar decreased, the procedure was discontinued to allow it to dislodge naturally. Clinical discussion Bezoars may be caused by gastric surgery, increased fiber diet, and psychiatric illness. As seen in this case, residual suture material caused bezoar formation. Bezoars mainly occur in the stomach and small intestines, but they can also occur in the afferent jejunal loop, as seen in this case. Conclusion Surgeons should be careful not to leave behind suture material during gastric surgery. However, bezoar formation should be considered in patients complaining of abdominal pain even if they did not undergo gastrectomy.

The Role of Endoscopic Management in Afferent Loop Syndrome

“…Lee described the use of a retrieval basket to break down a phytobezoar to relieve afferent loop obstruction in a 44-year-old woman with a previous pylorus-preserving pancreaticoduodenectomy. 28 Kuo et al 29 first described the use of endoscopic electrohydraulic lithotripsy in fragmenting large phytobezoars in a series of 11 patients with phytobezoars greater than 5 cm. Technical success was excellent, with phytobezoar fragmentation and clearance in 100% of patients.…”

Bezoar gastrointestinal: Revisión sistemática de la literatura

“…Su ubicación más frecuente es el estómago, seguida del intestino delgado, localizándose entre 50 y 70 cm por encima de la válvula ileocecal. (15). Según su composición, se pueden clasificar en diferentes tipos, de este modo, se reconocen los fitobezoares (compuestos por alimentos con base de celulosa), tricobezoares (formados por pelos y restos alimentarios), y menos frecuentemente, están los fármacobezoares, lactobezoares, polibezoares, entre otros (1).…”

“…Las manifestaciones clínicas asociadas a esta patología son: dolor abdominal vago, anorexia, vómitos, baja de peso, masa palpable, obstrucción intestinal, entre otras (1,5). A diferencia de los bezoares que se producen en el estómago, los del intestino delgado causan obstrucción y provocan síntomas vagos (15). Previamente, el diagnóstico de bezoar se realizaba de manera quirúrgica; sin embargo, con la incursión de la ecografía y la tomografía axial computarizada, es posible realizar este diagnóstico de manera prequirúrgica.…”

Hematological manifestations of trichobezoar in a child

“…Іноді воно переміщується в початковий відділ тонкого кишечника [4,5]. За своєю клінічною картиною дуже схоже на пухлину, тому необхідне проведення ретельної діагностики [6][7][8]. У статті наведено надзвичайно рідкісне клінічне спостереження трихобезоара шлунка великого розміру у дівчинки 5 років.…”