Bezoars are accumulations of indigestible contents within the gastrointestinal tract.
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Epidemiology
Associations
previous gastric surgery 2
psychiatric illness
Pathology
There are several types depending on the predominant components 2:
trichobezoar: a bezoar formed from hair, this has also been called Rapunzel syndrome when the tail of the trichobezoar extends some distance through the small bowel
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phytobezoar: composed of indigestible food material (e.g. cellulose) and are frequently reported in patients with impaired digestion and decreased gastric motility
diospyrobezoar: a subtype of phytobezoar secondary to the consumption of unripe persimmons 5
trichophytobezoar: a mixture of hair and plant-derived components
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pharmacobezoar: composed of conglomerates of xenobiotics (i.e. medications) such as tablets or pills
more common with large ingestions of modified-release products (e.g. extended-release, enteric-coated)
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some may form a bezoar from which slow and erratic desorption occurs resulting in unusually prolonged toxicity such as
meprobamate
theophylline
venlafaxine
clomipramine
quinidine
metal salts (magnesium, iron)
bromides
acetylsalicylate (enteric-coated aspirin)
others (e.g. cholestyramine, controlled-release nifedipine) may cause obstruction
lactobezoar: containing undigested milk curds
Radiographic features
Bezoars are known to cause small bowel obstruction and sometimes CT may demonstrate the bezoar as a mass in the obstructed segment of bowel. The bezoar may be outlined by fluid in the proximally dilated small bowel, and the mass may be mottled owing to air trapped within it.
Treatment and prognosis
Management options broadly include 5,6:
chemical dissolution (e.g. with Coca-Cola®)
endoscopic fragmentation and/or removal
surgical removal
History and etymology
Premodern medicine considered bezoars a special kind of stone with antidote properties. Until the 18th century a gold mounted bezoar was included in the crown jewels. Some ancient pharmacopoeias list 'unicorn horns' as an acceptable alternative if a bezoar is not available. In the late 15th century, Eastern porcupine bezoars were considered especially valuable 4.
Differential diagnosis
in small bowel loops consider small bowel feces sign 3
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