Bezoars: A Rare, Late Complication of Roux-en-Y Gastric Bypass and a Novel Endoscopic Technique for Treatment

Kanwar, Pushpjeet; Cheung, Derrick; Verma, Siddarth; Vlodov, Jane; Arya, Mukul

doi:10.14309/00000434-201610001-02273

Cited by 2 publications

(2 citation statements)

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“…Nutritional counseling is essential to prevent bezoar formation and recurrence, which has a 14% risk of recurrence [46]. Dietary counseling should include eating small meals, increasing fluid intake, chewing slowly and carefully, and avoiding highfiber foods [40].…”

Section: Bezoarsmentioning

confidence: 99%

Causes of Intestinal Obstructions after Roux-En-Y Gastric Bypass

Angulo Trejo,

García Ramos,

Antonio Angulo Trejo

et al. 2024

Practical Issues in Bariatric Surgery [Working Title]

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Obesity is a global pandemic and bariatric surgery is one of the fastest-growing surgical procedures performed worldwide. Roux-en-Y gastric bypass (RYGB) remains one of the most commonly performed bariatric procedures, with more than 480,000 procedures performed in 2022. The RYGB is characterized by a small proximal gastric pouch that is divided and separated from the distal stomach and anastomosed to an alimentary limb of the small intestine, thus bypassing a large portion of the small intestine preventing the absorption of nutrients. Small bowel obstruction after gastric bypass is not uncommon; the internal hernia is the most common etiology followed by postoperative adhesions, although there are less common causes. Diagnosis can be challenging due to the altered anatomy of the gastrointestinal tract; CT imaging is frequently used to establish the diagnosis. Since an internal hernia can be a life-threatening situation, early treatment is critical. The management of internal hernias after RYGB remains surgical. The urgency of surgical intervention depends on the clinical condition of the patient. Surgery should be attempted laparoscopically first if possible.

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Section: Bezoarsmentioning

confidence: 99%

Causes of Intestinal Obstructions after Roux-En-Y Gastric Bypass

Angulo Trejo,

García Ramos,

Antonio Angulo Trejo

et al. 2024

Practical Issues in Bariatric Surgery [Working Title]

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“…Bezoars are mass lesions of the gastrointestinal tract, which are composed of substances such as undigested food, medication, and hair [ 1 ]. Four basic types of bezoars have been defined: phytobezoar , trichobezoar , pharmacobezoar , and lactobezoar [ 2 ] . Bezoars have clinical importance because they may be associated with complications such as bleeding, intestinal obstruction, perforation, and fistula formation to adjacent organs or skin.…”

Section: Introductionmentioning

confidence: 99%

Occult Perforation of the Esophagus during Removal of an Enteral Feeding Tube: A Case Report and Literature Review

Alabdallat

Strandvik

Afifi

et al. 2023

Case Reports in Surgery

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Background. The use of oral or nasal route for enteral feeding is a standard practice in intensive care patients with a safe profile in general. However, complications associated with the insertion of a nasogastric (NGT) or orogastric tube (OGT) are common in the medical literature compared to the removal of such tubes. Case presentation. We presented a 38-year-old male who was involved in a motor-vehicle collision and found with low Glasgow Coma Scale outside his vehicle. He had polytrauma and was intubated—and commenced on enteral feeding via an OGT. Esophageal bezoar developed within a few days around the feeding tube, resulting in significant force being required to remove it, which was complicated by esophageal perforation. The esophageal injury was treated conservatively with uneventful recovery. Discussion and conclusions. Although limited case reports of esophageal enteral feeding bezoar formation do exist in the literature, we believe that this is the first case report of esophageal perforation due to the forceful removal of a wedged OGT secondary to esophageal bezoar formation. Morbidity associated with OGT/NGT is not common and may require a high index of suspicion to be identified. This is especially true if resistance is appreciated while removing the NGT/OGT. Gastroenterology consultation is recommended as early as possible to detect and manage any complications, however, their role was very limited in such stable case. In addition, early computed tomography (CT) can be considered for timely recognition of esophageal perforation. Non-operative management may be considered in stable patients, especially if the leak is in the cervical portion of the esophagus. Finally, prevention is better than cure, so being diligent in confirming NGT/OGT position, both radiologically and by measuring the tube length at the nostril/mouth, is the key to avoid misplacement and complication. This case raises the awareness of physician for such preventable iatrogenic event.

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Bezoars: A Rare, Late Complication of Roux-en-Y Gastric Bypass and a Novel Endoscopic Technique for Treatment

Cited by 2 publications

References 0 publications

Causes of Intestinal Obstructions after Roux-En-Y Gastric Bypass

Causes of Intestinal Obstructions after Roux-En-Y Gastric Bypass

Occult Perforation of the Esophagus during Removal of an Enteral Feeding Tube: A Case Report and Literature Review

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