Bezoar
The content of the article:
- Causes and risk factors
- Disease types
- Symptoms
- Diagnostics
- Treatment
- Possible complications and consequences
- Forecast
- Prevention
Bezoar (gastric calculus, or stone) is a foreign body formed as a result of the accumulation in the stomach cavity of particles of various origins (coarse plant fibers, hair) that cannot be digested.
Stomach stones form from several weeks to tens of years. The diameter of bezoars can reach from a few millimeters to 20-25 cm. There are cases when calculus almost completely filled the internal cavity of the stomach.
This is a rare pathology; only a few hundred cases of this disease have been described in the medical literature.
Bezoars - stomach stones
Causes and risk factors
In most cases, bezoars are formed from densely compressed coarse plant fibers (fruit seeds, fiber, peel). Such calculi are green and round, and have an unpleasant odor. They are detected in people whose diet contains a large amount of plant products: first of all, nuts, sunflower seeds, grapes, dates, figs, plums, persimmons. Factors predisposing to the formation of bezoars of plant origin:
- poor chewing of a food lump;
- decreased secretion of gastric juice;
- violation of gastric motility (as a result of which food is retained in its cavity);
- candidiasis of the stomach;
- undergone surgery on the stomach (gastric resection, vagotomy with pyloroplasty);
- high viscosity of mucus, which is part of the gastric juice.
Much less common are bezoars, consisting of a hairball with inclusions of food and mucus particles. Such calculi are usually found in people with mental disorders who pull out and bite their hair, in rare cases in those who professionally deal with hair (for example, hairdressers).
Other reasons for the formation of bezoars can be:
- swallowing plasticine, chewing gum;
- accumulation of insoluble drug residues in the stomach cavity, including activated carbon;
- swallowing blood with esophageal bleeding against the background of portal hypertension;
- the use of polish, BF glue, nitrolacquer inside;
- eating unheated beef, lamb or goat lard.
Swallowing chewing gum can lead to bezoar formation
In the first weeks of life, premature babies who are bottle-fed with high-calorie mixtures containing lactose and casein can also form calculi in the stomach cavity, called lactobesoars.
Disease types
Depending on the composition, bezoars are of the following types:
- trichobezoars (from hair);
- hemobezoars (from blood clots);
- phytobezoars (from plant fibers);
- shellacobezoars (from toxic substances);
- lactobesoars (from casein and lactose);
- pixobezoars (from resinous substances);
- sebobezoars (from fat);
- anthracobezoars (from drug residues);
- mixed bezoars.
Trichobezoar - bezoar formed from hair
Symptoms
The clinical picture is determined by the size of the bezoar. If the calculus is lightweight and small in diameter, symptoms are usually absent or there is little severity in the epigastrium.
Medium to large bezoars are manifested by the following features:
- fast feeling of fullness;
- pain in the stomach, worse after eating;
- belching;
- nausea, vomiting;
- feeling of a rolling ball in the stomach;
- general malaise, increased fatigue;
- weight loss.
Nausea and vomiting after a meal is a typical symptom of bezoars in the stomach.
Diagnostics
The main methods for diagnosing bezoar:
- X-ray of the stomach with barium sulfate contrast. The images show defects in filling the stomach of a rounded shape with clear edges.
- Gastro-fibroscopy. The method makes it possible to estimate the size of the bezoar and determine its composition.
Bezoars in the stomach on an x-ray
Sometimes a large bezoar in thin people can be detected by palpation of the abdomen.
Differential diagnosis with gastric tumors is required.
Treatment
Small bezoars can leave the patient's body along with vomit or feces. To remove phytobezoars, patients are prescribed to take orally a 10% sodium bicarbonate solution, and then massage the abdomen. After several procedures, the calculus breaks down into small parts, which are then excreted naturally. For the disintegration of lactobesoars and hemobezoars, repeated gastric lavages are performed. To accelerate the elimination of calculus particles from the digestive tract, patients can be prescribed prokinetics - drugs that improve the motor function of the stomach and intestines.
Light massage of the abdomen promotes the breakdown of bezoars into small pieces, which are subsequently removed naturally
If conservative treatment is ineffective (as well as with other types of bezoars), they resort to removal using a fibrogastroscope. A stone of considerable size is preliminarily crushed by laser or ultrasonic treatment.
Very hard and large bezoars are surgically removed in an open procedure (gastrotomy). If the calculus blocks the exit from the stomach, emergency surgery is indicated.
Large and hard bezoars are removed surgically - a gastrotomy is done
Possible complications and consequences
The most common complications of bezoars:
- damage by a stone to the gastric mucosa with the further formation of an ulcer in this place;
- the formation of pressure ulcers of the stomach wall, which can cause perforation;
- penetration of bezoar into the duodenal lumen, provoking the development of high mechanical intestinal obstruction.
Forecast
The forecast is favorable. After removal of calculi by conservative or surgical methods, complete recovery occurs.
Prevention
Prevention of bezoar formation includes the following measures:
- getting rid of the habit of biting hair;
- active treatment of mental disorders;
- restriction of rough plant foods in the diet;
- refusal to ingest drugs that are not able to be digested in the stomach.
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
