Vinesh Kumar, MBBS, MD1, Sanjay Kirshan Kumar, MBBS, FCPS2, Kashif Razzaq, MBBS, FCPS2, Ranjeet Kumar, MD, MRCP3, Sindhusha Veeraballi, MD4, Anish Kumar Kanukuntla, MD5, Priyaranjan Kata, MD6, Anjali Kirshan, MBBS7 1Hackensack Meridian Ocean Medical Center, Karachi, Sindh, Pakistan; 2Bahria Medical and Dental College, Karachi, Sindh, Pakistan; 3Liaquat University Of Medical and Health Sciences, Jamshoro, Sindh, Pakistan; 4Saint Michaels Medical Center, Newark, NJ; 5Hackensack Meridian Ocean Medical Center, Brick Township, NJ; 6Hackensack Meridian Ocean Medical Center, Brick, NJ; 7Peoples University of Medical & Health Science, Nawabshah, Sindh, Pakistan
Introduction: Bezoars are the collection of undigested or slowly digested materials in the gastrointestinal tract. The phytobezoars are the most common type. Phytobezoars develop rapidly and usually present with gastric outlet obstruction symptoms. Here in, we report a case of giant phytobezoar which responded to chemical dissolution with carbonated fluids (Coca-cola) and cellulase which was later removed by endoscopic procedure.
Case Description/Methods: A 65-year-old elderly male with a past medical history of arthritis presented with epigastric pain and vomiting for two months without any significant weight loss. He was found to have cholelithiasis and Cholecystitis on previous admission for similar complaints, for which he underwent laparoscopic cholecystectomy 1 month back. Persistent epigastric pain made us think of other possibilities. On further questioning, he said that he has been ingesting some herbs for arthritis. Subsequently, the patient underwent upper Gastrointestinal endoscopy, which revealed a stony hard, mobile, large bezoar of 9.0 × 10.0 cm. Endoscopic extraction was not possible due to hard consistency and huge size. Chemical dissolution with enzyme cellulase supplements and coca-cola drinks were advised to the patient. Two sequential endoscopies with an interval of 20 days demonstrated the reduced size of the bezoar, and it was successfully removed with the help of a polypectomy snare in piecemeal fashion. The patient remained symptoms free after the removal of the bezoar.
Discussion: Gastric bezoars are indigestible foreign material and present with reduced gastric motility. Bezoars may be asymptomatic, but can cause serious complications. Diagnosis is made by imaging or by direct endoscopic visualization. Small soft bezoars can pass the intestinal tract and can be managed medically by inhibiting the gastric acid secretion or neutralizing secreted acid by administering the proteolytic enzymes, cellulase, carbonated fluids given orally or by gastric lavage followed by endoscopic fragmentation. However, large hard bezoars need aggressive surgical management. We treated the giant phytobezoar with chemical dissolution followed by endoscopic removal in piecemeal fashion. This approach has prevented the patient from going through the complications of surgical approach. We recommend that the chemical dissolution can be tried even in giant bezoars before considering a surgical approach. Ours is the first case that demonstrated the response of giant phytobezoar to chemical dissolution.
Vinesh Kumar indicated no relevant financial relationships.
Sanjay Kirshan Kumar indicated no relevant financial relationships.
Kashif Razzaq indicated no relevant financial relationships.
Ranjeet Kumar indicated no relevant financial relationships.
Sindhusha Veeraballi indicated no relevant financial relationships.
Anish Kumar Kanukuntla indicated no relevant financial relationships.
Priyaranjan Kata indicated no relevant financial relationships.
Anjali Kirshan indicated no relevant financial relationships.
Vinesh Kumar, MBBS, MD1, Sanjay Kirshan Kumar, MBBS, FCPS2, Kashif Razzaq, MBBS, FCPS2, Ranjeet Kumar, MD, MRCP3, Sindhusha Veeraballi, MD4, Anish Kumar Kanukuntla, MD5, Priyaranjan Kata, MD6, Anjali Kirshan, MBBS7. P3103 - Combination of Chemical Dissolution and Endoscopic Removal as an Alternative to Surgical Removal of Huge Phytobezoar, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.