Gastric surgery and bezoars

• Published in: Digestive diseases and sciences 1992-11, Vol.37 (11), p.1694-1696
• Main Authors: TEBAR, J. C, ROBLES CAMPOS, R, PARILLA PARICIO, P, LUJAN MOMPEAN, J. A, ESCAMILLA, C, LIRON RUIZ, R, PELLICER FRANCO, E. M
• Format: Article
• Language: English
• Subjects: Adult; Aged; Bezoars - epidemiology; Bezoars - etiology; Bezoars - mortality; Biological and medical sciences; Digestive System; Disease Susceptibility; Female; Humans; Male; Medical sciences; Middle Aged; Peptic Ulcer - surgery; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - mortality; Retrospective Studies; Spain - epidemiology; Stomach - surgery; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/BF01299861

We present a series of 56 patients with gastrointestinal bezoar following previous gastric surgery for gastroduodenal peptic ulcer. The following parameters were studied: factors predisposing to bezoar formation (type of previous surgery, alimentation, and mastication), form of clinical presentation, diagnostic tests, and treatment. A bilateral truncal vagotomy plus pyloroplasty had been performed previously on 84% of patients, 44% revealed excessive intake of vegetable fiber, and 30% presented with bad dentition. The most frequent clinical presentation was intestinal obstruction (80%). This was diagnosed mainly by clinical data and simple abdominal radiology. The main exploratory technique for diagnosing cases of gastric bezoar was endoscopy. Surgery is necessary for treating the intestinal forms, and one should always attempt to fragment the bezoar and milk it to the cecum, reserving enterotomy and extraction for cases where this is not possible. The small intestine and stomach should always be explored for retained bezoars. Gastric bezoars should always receive conservative treatment, endoscopic extraction, and/or enzymatic dissolution; gastrotomy and extraction should be performed when this fails.