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Bezoar in gastro-jejunostomy presenting with symptoms of gastric outlet obstruction: a case report and review of the literature

DOI: 10.1186/1752-1947-2-323

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Abstract:

A 62-year-old Asian woman with a history of gastrojejunostomy for peptic ulcer disease was admitted to hospital with epigastric pain, vomiting and dehydration. All investigations concluded gastric outlet obstruction secondary to a "stricture" at the site of gastrojejunostomy. Subsequent laparotomy revealed that the cause of the obstruction was a bezoar.Many bezoars can be removed endoscopically, but some will require operative intervention. Once removed, emphasis must be placed upon prevention of recurrence. Surgeons must learn to recognise and classify bezoars in order to provide the most effective therapy.Gastric outlet obstruction (GOO) in adults is not a single entity; it is the pathophysiological consequence of any disease process that produces a mechanical impediment to gastric emptying. There are benign and malignant causes. In the past, peptic ulcer disease was more prevalent than malignant causes, currently, it only accounts for 5% of all cases of GOO [1]. With the advent of proton pump inhibitors and Helicobacter pylori eradication therapy, this benign cause has become less common. Andersson and Bergdahl reported [2] that 67% of patients have GOO secondary to malignancy. Other benign intraluminal causes in adults include gastric polyps, caustic ingestion, gallstone obstruction (Bouveret syndrome), and bezoars.Bezoars, concretions of indigestible material in the gastrointestinal tract, have been known to occur in animals for centuries. The incidence of bezoars in adult patients has increased as a result of operative manipulation of the gastrointestinal tract. Although bezoars are often recognised radiologically, endoscopy provides the most accurate means of identification. Many bezoars can be removed endoscopically, but some will require operative intervention. Once removed, emphasis must be placed upon prevention of recurrence. Surgeons must learn to recognise and classify bezoars in order to provide the most effective therapy.We report a case of a 62-year

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