Intestinal obstruction is a common clinical entity encountered in surgical practice.The objective of this report is to corroborate an atypical scenario of intestinal obstruction in a Chinese patient and to focus on th...Intestinal obstruction is a common clinical entity encountered in surgical practice.The objective of this report is to corroborate an atypical scenario of intestinal obstruction in a Chinese patient and to focus on the diagnosis and treatment.A 27-year-old male presented with a history of gastric pain combined with nausea and abdominal distension that had been present for 5 d.The presence of a foreign body was detected by computed tomography and observed as an abnormal density within the stomach.A diospyrobezoar was revealed during gastroscopy,the extraction of which was preventeddue to its size and firmness.An endoscopic holmium laser joined with a snare was used to fragment the obstruction,which was followed by management with a conservative"sandwich"treatment strategy involving intestinal decompression with an ileus tube and Coca-Cola lavage between endoscopic lithotripsy fragmentation procedures.This strategy resulted in the successful removal of the diospyrobezoar along with multiple small bowel obstructions.The patient was discharged after abatement of symptoms.The case presented here demonstrates the implementation of a conservative,yet successful,treatment as an alternative to conventional surgical removal of intestinal obstructions.展开更多
AIM:To evaluate the efficacy of cola treatment for gastric phytobezoars,including diospyrobezoars.METHODS:A total of 17 patients(range:48 to 78 years) with symptomatic gastric phytobezoars treated with cola and adjuva...AIM:To evaluate the efficacy of cola treatment for gastric phytobezoars,including diospyrobezoars.METHODS:A total of 17 patients(range:48 to 78 years) with symptomatic gastric phytobezoars treated with cola and adjuvant endoscopic therapy were reviewed.Three liters of cola lavage(10 cases) or drink(7 cases) were initially used,and then endoscopic fragmentation was done for the remnant bezoars by using a lithotripsy basket or a polypectomy snare.The overall success of dissolving a gastric phytobezoars with using three liters of cola and the clinical and endoscopic findings were compared retrospectively between four cases of complete dissolution by using only cola and 13 cases of partial dissolution with cola.RESULTS:After 3 L of cola lavage or drinking,a complete dissolution of bezoars was achieved in four patients(23.5%),while 13 cases(76.5%) were only partially dissolved.Phytobezoars(4 of 6 cases) were observed more frequently than diospyrobezoars(0 of 11) in the group that underwent complete dissolution(P = 0.006).Gender,symptom duration,size of bezoar and method of cola administration were not significantly different between the two groups.Twelve of 13 patients with residual bezoars were completely treated with a combination of cola and endoscopic fragmentation.CONCLUSION:The rate of complete dissolution with three liters of cola was 23.5%,but no case of diospyrobezoar was completely dissolved using this method.However,pretreatment with cola may be helpful and facilitate endoscopic fragmentation of gastric phytobezoars.展开更多
AIM:To describe the clinical characteristics of patients with gastric or intestinal bezoars recently treated in our hospital.METHODS:In this study,a retrospective chart review of consecutive patients with gastrointest...AIM:To describe the clinical characteristics of patients with gastric or intestinal bezoars recently treated in our hospital.METHODS:In this study,a retrospective chart review of consecutive patients with gastrointestinal bezoars,who were treated at the Samsun Education and Research Hospital between January 2006 and March 2011,was conducted.Data on demographic characteristics,clinical presentation,history of risk factors,diagnostic procedures,localization of bezoars,treatment interventions,and postoperative morbidity and mortality rates were collected and evaluated.RESULTS:Forty-two patients [26 (61.9%) males and 16 (31.1%) females] with a mean±SD (range) age of 55.8±10.5 (37-74) years were enrolled in this study.Thirty-six patients (85.7%) had one or more predisposing risk factors for gastrointestinal bezoars.The most common predisposing risk factor was a history of previous gastric surgery which was identified in 18 patients (42.8%).Twenty three patients (54.8%) had multiple predisposing risk factors.Phytobezoars were identified in all patients except one who had a trichobezoar in the stomach.Non-operative endoscopic fragmentation was performed either initially or after unsuccessful medical treatment in 14 patients with gastric bezoars and was completely successful in 10 patients (71.5%).Surgery was the most frequent treatment method in our study,which was required in 28 patients (66.7%).Intestinal obstruction secondary to bezoars was the most common complication (n=18,42.8%) in our study.CONCLUSION:The presence of multiple predisposing factors may create a synergistic effect in the development of bezoars.展开更多
基金Supported by Projects of Administration of Traditional Chinese Medicine of Zhejiang Province,No.2012ZA084
文摘Intestinal obstruction is a common clinical entity encountered in surgical practice.The objective of this report is to corroborate an atypical scenario of intestinal obstruction in a Chinese patient and to focus on the diagnosis and treatment.A 27-year-old male presented with a history of gastric pain combined with nausea and abdominal distension that had been present for 5 d.The presence of a foreign body was detected by computed tomography and observed as an abnormal density within the stomach.A diospyrobezoar was revealed during gastroscopy,the extraction of which was preventeddue to its size and firmness.An endoscopic holmium laser joined with a snare was used to fragment the obstruction,which was followed by management with a conservative"sandwich"treatment strategy involving intestinal decompression with an ileus tube and Coca-Cola lavage between endoscopic lithotripsy fragmentation procedures.This strategy resulted in the successful removal of the diospyrobezoar along with multiple small bowel obstructions.The patient was discharged after abatement of symptoms.The case presented here demonstrates the implementation of a conservative,yet successful,treatment as an alternative to conventional surgical removal of intestinal obstructions.
文摘AIM:To evaluate the efficacy of cola treatment for gastric phytobezoars,including diospyrobezoars.METHODS:A total of 17 patients(range:48 to 78 years) with symptomatic gastric phytobezoars treated with cola and adjuvant endoscopic therapy were reviewed.Three liters of cola lavage(10 cases) or drink(7 cases) were initially used,and then endoscopic fragmentation was done for the remnant bezoars by using a lithotripsy basket or a polypectomy snare.The overall success of dissolving a gastric phytobezoars with using three liters of cola and the clinical and endoscopic findings were compared retrospectively between four cases of complete dissolution by using only cola and 13 cases of partial dissolution with cola.RESULTS:After 3 L of cola lavage or drinking,a complete dissolution of bezoars was achieved in four patients(23.5%),while 13 cases(76.5%) were only partially dissolved.Phytobezoars(4 of 6 cases) were observed more frequently than diospyrobezoars(0 of 11) in the group that underwent complete dissolution(P = 0.006).Gender,symptom duration,size of bezoar and method of cola administration were not significantly different between the two groups.Twelve of 13 patients with residual bezoars were completely treated with a combination of cola and endoscopic fragmentation.CONCLUSION:The rate of complete dissolution with three liters of cola was 23.5%,but no case of diospyrobezoar was completely dissolved using this method.However,pretreatment with cola may be helpful and facilitate endoscopic fragmentation of gastric phytobezoars.
文摘AIM:To describe the clinical characteristics of patients with gastric or intestinal bezoars recently treated in our hospital.METHODS:In this study,a retrospective chart review of consecutive patients with gastrointestinal bezoars,who were treated at the Samsun Education and Research Hospital between January 2006 and March 2011,was conducted.Data on demographic characteristics,clinical presentation,history of risk factors,diagnostic procedures,localization of bezoars,treatment interventions,and postoperative morbidity and mortality rates were collected and evaluated.RESULTS:Forty-two patients [26 (61.9%) males and 16 (31.1%) females] with a mean±SD (range) age of 55.8±10.5 (37-74) years were enrolled in this study.Thirty-six patients (85.7%) had one or more predisposing risk factors for gastrointestinal bezoars.The most common predisposing risk factor was a history of previous gastric surgery which was identified in 18 patients (42.8%).Twenty three patients (54.8%) had multiple predisposing risk factors.Phytobezoars were identified in all patients except one who had a trichobezoar in the stomach.Non-operative endoscopic fragmentation was performed either initially or after unsuccessful medical treatment in 14 patients with gastric bezoars and was completely successful in 10 patients (71.5%).Surgery was the most frequent treatment method in our study,which was required in 28 patients (66.7%).Intestinal obstruction secondary to bezoars was the most common complication (n=18,42.8%) in our study.CONCLUSION:The presence of multiple predisposing factors may create a synergistic effect in the development of bezoars.
