Recurrent gastric metal bezoar: a rare cause of gastric outlet obstruction

Abstract

A 52-year-old male patient with psychiatric medical history who presented to the emergency department five times during a period of 5 years due to gastric outlet obstruction manifested mainly by abdominal pain, vomiting and haematemesis after intentionally ingesting metals and which necessitate several surgical interventions. Lately, he presented with generalised peritonitis due to gastric perforation from metal bezoars. Chronic abdominal symptoms in patient having a psychiatric disorder can be due to foreign body ingestion. Treatment is often surgical and the whole digestive tract should be explored to avoid retained bezoars.

Pathophysiological and clinical aspects of the diagnosis and treatment of bezoars

“…Apart from the aforementioned types of bezoars, other substances may also contribute to their formation: unusual and peculiar materials that have been described in the past include metals [27,28], ceramics (kaolin) [29], fungi ( Candida ) [30], plastic, parasites (ascaris) and paper [4]. In the future, more materials may be recorded as bezoar contributors, because all indigestible food substances and foreign bodies may cause the formation of a mass in the digestive tract with the sticky intervention of mucus.…”

Surgical Management of Massive Metal Bezoar

“…Bezoars are classified according to their composition into phytobezoars, pharmacobezoars, trichobezoars, lactobezoars, and foreign body bezoars [ 2 ]. Metal foreign body bezoars are the least common form, with a few cases have been reported in the literature [ 3 ].…”

“…Foreign body (FB) ingestion is common within the pediatric age group, and to a lesser extent in adults, especially those with an underlying psychiatric illness [1][2][3]. These indigestible foreign bodies accumulate within the gastrointestinal tract and are known as bezoars.…”

“…Ingestion of a massive number of sharp nails is an example of metal bezoars with few cases have been reported in the literature. Those patients usually require intervention as they carry a risk of complications in the form of perforation, bleeding, and obstruction [1][2][3].…”

Stomach Bezoaris, Causes of Development, Diagnosis and Methods of Treatment

“…Phytobezoаr is the most common type of bezoar, which occurs in about 75 % of all types of bezoar, and is formed as a result of the use of a large number of bezorogenic products of plant origin, including grapes, persimmon (diospirobesoar), dates, figs, dogwood, cherries and sweet cherries, corn, pineapple [1,2,3]. Such types are also distinguished: lactobesoir -accumulation of lactose and casein (is common for children) [4]; pharmacobezoir -caused by the use of tableted drugs [5], which include: aluminum hydrochloride gel, intestinal aspirin, sucralfate, cholestyramine, nifedipine [6,7]; Sebobezoar -is formed by refractory animal fats in the form of fatty conglomerates, shellacobezoar (or pixo-or desmobezoar) -resins and bitumen [1,8]; trichobezoar -the aggregation of hair between the folds of the stomach [9,10], which occurs more often in women up to 30 years [11], is associated with mental illness and bad habits: trichotomomania (tearing hair) and trichophagia (swallowing hair), it can "tail" spread to the intestine (Rapunzel syndrome) [12]; polybezoar -mixed genesis [1,8].…”