Bezoars are accumulations of indigestible contents within the gastrointestinal tract 2.
They 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.
There are several subtypes depending on the predominant components:
- 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.
phytobezoar: composed of indigestible food material (e.g. cellulose) and are frequently reported in patients with impaired digestion and decreased gastric motility.
- diospyrobezoar is a subtype of phytobezoar secondary to the consumption of unripe persimmons 5
- pharmacobezoar: (or medication bezoars) mostly undigested tablets or semi-liquid masses of drugs.
- lactobezoar: containing undigested milk curds
- previous gastric surgery 2
- psychiatric illness
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.
- in small bowel loops consider small bowel faeces sign 3
- 1. Delabrousse E, Brunelle S, Saguet O et-al. Small bowel obstruction secondary to phytobezoar CT findings. Clin Imaging. 25 (1): 44-6. Clin Imaging (link) - Pubmed citation
- 2. Ripollés T, García-aguayo J, Martínez MJ et-al. Gastrointestinal bezoars: sonographic and CT characteristics. AJR Am J Roentgenol. 2001;177 (1): 65-9. AJR Am J Roentgenol (full text) - Pubmed citation
- 3. Chen YC, Liu CH, Hsu HH et-al. Imaging differentiation of phytobezoar and small-bowel faeces: CT characteristics with quantitative analysis in patients with small- bowel obstruction. Eur Radiol. . doi:10.1007/s00330-014-3486-1 - Pubmed citation
- 4. Barroso M. Geological Society, London, Special Publications. 2013;375 (1): . doi:10.1144/SP375.11
- 5. Eng K, Kay M. Gastrointestinal bezoars: history and current treatment paradigms. (2012) Gastroenterology & hepatology. 8 (11): 776-8. Pubmed