N 5 (177) 2021. P. 65–70

BEZOAR IN THE PRACTICE OF GENERAL PRACTITIONER AND PEDIATRICIAN: CLINICAL CASE — RAPUNZEL SYNDROME

M. V. Dubkovska, T. M. Khimenko, O. V. Kochkariov, O. V. Fedorenko

Odesa National Medical University MH of Ukraine, Odesa, Ukraine

DOI 10.54229/2226-2008-2021-5-12

Introduction. Bezoar is a cluster of foreign, inedible or difficult to digest objects in the digestive tract (especially in the stomach). Depending on the composition, there are: phytobezoars, trichobezoars, pharmacobezoars, lactobezoars. Patients may not have any symptoms for years, and their appearance is associated with an bezoar size enlargment, then there is abdominal pain, bloating, nausea and vomiting, a feeling of rapid satiety, anorexia and weight loss. The small bowel obstruction is the often cause of acute surgical pathology in the case of bezoar. It is important to pay attention to the peculiarities of the patient’s behavior, halitosis, spotted alopecia.

The purpose of this publication was to raise the awareness of pediatricians and general practitioners in the diagnosis and management of patients with bezoars. The article presents a review of the literature and the clinical case of trichobezoar (Rapunzel syndrome) in a 14-year-old girl.

Conclusions. Bezoar, regardless of its nature, disrupts the function of the gastrointestinal tract and can cause acute surgical complications patients of all ages. General practitioners and pediatricians, taking into account the risk factors and clinical symptoms, may suspect bezoar formation in the early stages. In pediatric practice at the stage of primary diagnostic search, ultrasound can be recommended as a less invasive, but quite informative method. The “golden standard” for verification and treatment of uncomplicated forms of bezoar is the endoscopic method, regardless of age. Phytobezoars are less common in our region, but the processes of globalization, migration and increase in the diet of exotic fruits and vegetables may actualize this pathology. Adolescents, mostly girls who have long-term dyspeptic symptoms, alopecia, weight loss, especially if it occurs against the background of difficult social circumstances or pre-existing psychiatric disorders, are at risk of developing trichobezoar, so they need careful examination and consultation with a psychiatrist.

Key words: bezoar, trichobezoar (Rapunzel syndrome), general practice, pediatrics.

 

References

  1. Iwamuro M et al. Review of the diagnosis and management of gastrointestinal bezoars. World J Gastrointest Endosc 2015 April 16;7(4):336-345 DOI:10.4253/wjge.v7.i4.336
  2. Lin-na Liu* et al. Clinical Features, Risk Factors, and Endoscopic Treatment of Bezoars:A Retrospective Analysis from a Single Center in Northern China. Med Sci Monit 2020;26:e926539 DOI:10.12659/MSM.926539
  3. Gonuguntla V, Joshi D Rapunzel Syndrome: A Comprehensive Review of an Unusual Case of Trichobezoar. Clin. Med. Res. 2009 Sep;7(3):99-102. Avaliable at:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2757434/
  4. Plataras C et al. An unusual cause of small bowel obstruction in children:lentil soup bezoar. BMJ Case Rep. 2014. DOI: 10.1136/bcr-2013-203316
  5. Manatakis DK et al. Gastrointestinal Seed Bezoars: A systematic Review of Case Reports and Case series. Cureus. 2019;11(5):e4686. DOI 10.7759/cureus.4686
  6. Hemmasi GR et al. Risk factors, endoscopic findings, and treatments in upper gastrointestinal bezoars:multi-center experience in Iran. Gastroenterol Hepatol Bed Bench. 2021;14(2):160-164
  7. Fallon SC, Slater BJ, Larimer EL, et al. The surgical management of Rapunzel syndrome:a case series and literature review. J Pediatr Surg 2013;48:830.
  8. Park SE, Ahn JY, Jung HY, et al. Clinical outcomes associated with treatment modalities for gastrointestinal bezoars. Gut Liver. 2014;8:400.
  9. Hu X, Zhang RY, Liu WH. A novel endoscopic treatment for giant gastric bezoars:guidewire-based seesaw-type fragmentation using a specific bezoaratom kit. Endoscopy. 2020;52:E146.
  10. Jain SA, Agarwal L, Khyalia A, et al. Pharmacobezoar-a rare case presented as gastric outlet obstruction. J Surg Case Rep. 2018;2018:rjy116.
  11. Abou Azar S, Wehbe MR, Jamali S, Hallal A. Small Bowel Obstruction Secondary to a Metamucil Bezoar: Case Report and Review of the Literature. Case Rep Surg 2017;2017:2702896.
  12. Gaillard F, Saber M. Bezoar. Reference article, Radiopaedia. org. (accessed on 13 Oct 2021). Available at: https: //radiopaedia.org/articles/987
  13. Ripollés T. Gastrointestinal Bezoars Sonographic and CT Characteristics. American Journal of Roentgenology. 2001;177:65-69. DOI: 10.2214/ajr.177.1.1770065
  14. Lian-qin Kuang et al. Prediction of Small Bowel Obstruction Caused by Bezoars Using Risk Factor Categories on Multidetector Computed Tomographic Findings. BioMed Research International Volume 2016, Article ID 6569103, 9 pages. URL: http://dx.doi.org/10.1155/2016/6569103
  15. Marilina A et al. A non-occlusive bezoar of caecum in a 7-year-old child:ultrasound detection and multimodality imaging management. J Ultrasound 2016;19:223-226. DOI: 10.1007/s40477-015-0165-2.
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