Bezoar

Background

Stomach anatomy

• Mass within the gastrointestinal system
• Made up of organic or inorganic material
• Commonly from eating hair or indigestible materials
• Risk factors include intellectual disability or emotional disturbance
• More common females aged 10 to 19 years of age

Risk Factors

• Gastric dysmotility
• Gastric outlet obstruction
• Dehydration
• Medications
  • Anticholinergic
  • Opiates

Types of Bezoars

• Food boluses
• Lactobezoar (seen in premature infants receiving formula)
• Pharmacobezoars (medications, especially overdoses of sustained-release medications
• Phytobezoars (indigestible plant material)
• Trichobezoar (hair)

Foreign Body Types

• Ear foreign body
• Nasal foreign body
• Ocular foreign body
• Aspirated foreign body
• GI
  • Ingested foreign body
    • Bezoar
    • Body packing
    • Esophageal foreign body removal with foley catheter
  • Rectal foreign body
• Soft tissue foreign body

Clinical Features

• Indigestion
• Abdominal pain
• Nausea and vomiting
• Diarrhea
• Gastric ulcers

Differential Diagnosis

Epigastric Pain

• Gastroesophageal reflux disease (GERD)
• Peptic ulcer disease with or without perforation
  • Zollinger-Ellison syndrome
• Gastritis
• Pancreatitis
• Gallbladder disease
  • Acute cholecystitis
  • Cholangitis
  • Symptomatic cholelithiasis
  • Acalculous cholecystitis
• Myocardial Ischemia
• Splenic Infarctionenlargement/rupture/aneurysm
• Pericarditis/Myocarditis
• Aortic dissection
• Hepatitis
• Pyelonephritis
• Pneumonia
• Pyogenic liver abscess
• Fitz-Hugh-Curtis Syndrome
• Hepatomegaly due to CHF
• Bowel obstruction
• SMA syndrome
• Pulmonary embolism
• Bezoar
• Ingested foreign body
• See Nausea and vomiting

Management

• Removal either endoscopically if small but may require surgical removal when large

See Also

• Ingested foreign body