Cellulase treatment in 3 cases of large phytobezoars

A 76-year-old gentleman presented with anemia. He had a history of perforated duodenal ulcer six years ago, with Billroth II repair performed. A large gastric bezoar (8×6 cm 2 ) with a clean base ulcer at the anastomotic junction was found during the initial oesophago-gastro-duodenoscopy (OGDS). Rapid urease test was negative. He presented with melena during the subsequent follow up (OGDS showed a Forrest Ib prepylori ulcer). We have successfully removed the gastric bezoar with dissolution therapy initially (injection of cokecola into the bezoar, followed by drinking 325 mL Coca-Cola TM twice daily), followed by four attempts of OGDS with endoscopic fragmentation. Histopathology reported as degenerated vegetable matter, acellular debris mixed with scattered fungal and bacterial colonies, which was compatible with bezoar. Follow-up OGDS showed complete clearance of the bezoar. Coca-Cola TM ingestion should be considered as initial treatment as it is non-invasive, and it enables further successful endoscopic fragmentation.

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A giant gastric bezoar in Billroth II stomach: a case report on successful endoscopic removal via repeated fragmentation and dissolution technique negating the need for surgical intervention

Chieng

Goh

2016

Gastroenterol Insights

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PhytobezoarInduced Small Bowel Obstruction in a Young Male with Virgin Abdomen

Manning

Vattipallly

Niazi

et al. 2015

J Gastrointest Dig Syst

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Phytobezoars are a rare cause of small bowel obstruction. Such cases are most commonly associated with previous abdominal surgery or poor dentition or psychiatric conditions. A 40 year old man with a virgin abdomen and excellent dentition and no underlying psychiatric condition presented with an acute abdomen. CT scan revealed a transition point between dilated proximal loops of small bowel and collapsed distal loops. Exploratory laparotomy revealed a phytobezoar unable to be milked into the cecum and an enterectomy with primary anastamosis was performed without complication. A detailed history revealing several less common predisposing factors for phytobezoars should increase clinical suspicion of a phytobezoarinduced small bowel obstruction in the setting of an acute abdomen. Vigilance in presentations of an acute abdomen improves the usefulness of medical imaging, such as a CT, to detect phytobezoars. Understanding mechanisms of phytobezoar formation helps guide management and may prevent surgery.

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Cellulase treatment in 3 cases of large phytobezoars

Cited by 2 publications

References 6 publications

A giant gastric bezoar in Billroth II stomach: a case report on successful endoscopic removal via repeated fragmentation and dissolution technique negating the need for surgical intervention

A giant gastric bezoar in Billroth II stomach: a case report on successful endoscopic removal via repeated fragmentation and dissolution technique negating the need for surgical intervention

PhytobezoarInduced Small Bowel Obstruction in a Young Male with Virgin Abdomen

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