Gastric Bezoar - hair and textile fibers

Case contributed by Alejandro Planas Callao
Diagnosis almost certain

Presentation

Epigastric pain, vomiting, and abdominal mass on palpation.

Patient Data

Age: 50 years
Gender: Male

Enlarged gastric silhouette presenting as an epigastric mass, which shows a mottled gas pattern.

Case Discussion

An immigrant patient presented to the emergency department with recurrent epigastric pain and vomiting. A review of the medical history showed a previous CT diagnosis of hair and textile fiber gastric bezoar.

Gastrointestinal bezoars are aggregates of undigested material that accumulate in the digestive tract. Risk factors for their formation include gastric surgery, impaired gastric motility (e.g. gastroparesis secondary to diabetes mellitus), cystic fibrosis, or psychiatric illness, among others 1.

Our patient also suffered from the syndrome of the extreme migratory duel, also known as "Ulysses syndrome". This syndrome is a psychosomatic condition associated with population migrations and exposition to stressors related to migratory journeys 2. This condition triggered the formation of the bezoar in this case.

Treatment with cellulose, Coca-Cola, and a liquid diet was decided since he was not a candidate for surgical treatment.

Although in this case the diagnosis of bezoar was already made, this abdominal X-ray is a good example of how a gastric bezoar could be seen by plain radiography.

This case has been submitted thanks to Dr. Marina Pelfort Moreno, whom we thank for her collaboration.

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