IS Case 388: Bezoar

Trushar Sarang, MD


2009 URMC Imaging Sciences
Publication Date: 2010-03-09

History

Patient is a 19-year-old male with clinical suspicion for small bowel obstruction.

Findings

Calcified mass in the stomach consistent with bezoar.

Diagnosis

Bezoar

Discussion

A bezoar is any type of indigestible material that accumulates in the gastrointestinal tract, most commonly the stomach. There are many different types of bezoars, depending on the etiology and composition. Different materials include hair (trichobezoars) or vegetable fiber (phytobezoars).

Historically, the word bezoar is derived from the Persian word 'padzahr' which means antidote. There is a long history of bezoars providing neutralization of toxins, such as arsenic.

There is a female predominance of more than 50%. Predisposing factors include any etiology for gastric paresis including narcotics or vagotomy. Symptoms include anorexia, bloating, and early satiety. It may cause small bowel obstruction after forming in the stomach.

The radiographic findings are of a mass in the gastric lumen which mimics food. Barium studies demonstrate a filling defect with contrast seeping into the heterogeneous mass. Delayed films are helpful because the barium will be retained in the bezoar.

The differential includes gastric adenoma or adenocarcinoma or benign tumors such as a gastrointestinal stromal tumor (GIST) or leiomyosarcoma.

References

  1. Hewitt AN, Levine MS, Rubesin SE, Laufer I. Gastric bezoars: reassessment of clinical and radiographic findings in 19 patients. Br J Radiol. 2009 Nov;82(983):901-7. PMID: 19433488
  2. Johnson CD, Schmit GD. Mayo Clinic Gastrointestinal Imaging Review. Mayo Clinic Scientific Press, 2005.

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