• Journal of Gastric Cancer
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• v.10 no.2
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• pp.84-86
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• 2010

Bezoars are retained concretions of undigested animal or vegetable material that can produce gastrointestinal obstruction, ulceration, and bleeding. Therapeutic options for gastric bezoars include enzyme therapy (papain, cellulase, or acetylcysteine), endoscopic disruption and removal, and surgical removal. Multiple large gastric bezoars generally require conventional surgical management through an upper abdominal incision. With the recent improvement of laparoscopy, a lot of portions of abdominal operations have been performed laparoscopically. We successfully removed multiple large gastric phytobezoars in a 52-year-old female completely through laparoscopy. This supported the feasibility of laparoscopic surgery for patients with gastric bezoars.

• Clinical and Experimental Pediatrics
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• v.48 no.4
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• pp.433-437
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• 2005

Bezoars are concretions commonly found in the stomach and small bowel, and four types of bezoars have been described based on their composition : trichobezoar, phytobezoar, lactorbezoar, and miscellaneous. Bezoars most often develop after gastric operations that alter the motility, emptying, and grinding of food in the stomach. Trichobezoars are most common in female children with normal gastrointestinal function and are usually associated with pica, mental retardation, and psychiatric disorders. Although uncommon, bezoars are a well-recognized cause of chronic abdominal complaints which, when undiagnosed, can result in serious complications including gastric ulceration, bleeding, perforation, intussusception and small bowel obstruction. Mortality rates of up to 30 percent have been reported in adults. Trichotillomania is behaviors surrounding hair-pulling, including stroking and playing with hair before pulling, or biting and swallowing the hair after it has been pulled(trichophagia). The most notorious of the medical sequelae of trichotillomania is the trichobezoar. We experienced a case of trichobezoar in an 11-year-old girl who frequently swallowed her hairs from age 4 years up to age 7 years, resulting in intermittent abdominal pain, nausea, and vomiting.

• Journal of Yeungnam Medical Science
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• v.30 no.1
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• pp.62-65
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• 2013

Gastric bezoars are concretion of undigested material in the gastrointestinal tract. In the past, gastric bezoars were generally treated with surgical management. Recently, the efficacy of oral intake or endoscopic injection therapy with Coca-Cola has been reported. We report a case of a 47-year-old-man with huge gastric bezoar ($4{\times}2.5$ cm) that was successfully removed by endoscopic fragmentation with Coca-Cola injection. Compared with a single endoscopic fragmentation therapy, the combination therapy with Coca-Cola injection shortened the procedure time and reduced the complication associated with fragmented bezoar.

• Advances in pediatric surgery
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• v.10 no.1
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• pp.43-46
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• 2004

Two cases of trichobezoar with unusual presentation in female children are described. The first case is a 7-year-old female with a 3-day history of abdominal pain, obstipation, and emesis. She developed intestinal obstruction and showed double bezoars in the stomach and intestine respectively. She had been in a habit of biting or sucking hairs before sleeping from infancy until 5 years of age. The other patient is a 6-year-old girl referred for an epigastric mass, emotional disturbance and trichotillomania. In spite of the psychological treatment, 4 laparotomies were necessary due to repeated recurrences.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.16 no.2
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• pp.127-130
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• 2013

Rapunzel syndrome refers to a very rare condition in which swallowed hair forms a gastric trichobezoar that has a long tail extending into the small bowel. We describe a case of Rapunzel syndrome in an 8-year-old girl who presented with abdominal mass, epigastric pain and vomiting. Abdominal computed tomography scan showed a markedly dilated stomach filled with coarse heterogeneous materials. Upper gastrointestinal endoscopy revealed a huge hairy ball with a tail extending through the pylorus. We performed a surgical laparotomy and successfully removed a huge trichobezoar with a long tail extending into the middle portion of jejunum. Psychiatric consultation with review showed her past history of trichotillomania and trichophagia 4 years ago. But her parents denied further psychiatric therapy and she was lost to the follow-up. Rapunzel syndrome should be included in the differential diagnosis in children with chronic abdominal pain and trichophagia.

• Journal of Gastric Cancer
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• v.11 no.4
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• pp.230-233
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• 2011

Regarding the removal of a gastric bezoar, laparoscopic surgery was performed and it was shown that the laparoscopic approach is safe and feasible. However, the laparoscopic method has the risk of intraabdominal contamination, when the gastric bezoar is retrieved from the gastric lumen in the peritoneal cavity. We developed and applied a new procedure for the removal of the gastric bezoar using one surgical glove and two wound retractors as a fashion of intragastric single port surgery. Herein we present this new minimal invasive procedure, so named "hybrid access surgery" which involves the use of existing devices and overcomes the weakness of laparoscopic removal of the gastric bezoar. Our new procedure, combining the concept of intragastric and single port access, is acceptable and feasible to retrieve the gastric bezoar. In the future, this procedure may be one of the alternative procedures for retrieving gastric bezoar even when it is incarcerated in the pylorus.

• Journal of Yeungnam Medical Science
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• v.23 no.2
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• pp.247-251
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• 2006

Bezoars are collections or concretions of indigestible foreign material that accumulate and coalesce in the gastrointestinal tract; they usually occur in patients who have undergone gastric surgery and have delayed gastric emptying. Treatment options include dissolution with enzymes, endoscopic fragmentation with removal or aspiration, and surgery. Recently, the efficacy of nasogastric lavage or endoscopic infusion of Coca-Cola for the dissolution of phytobezoar have been reported. We report a case of phytobezoar successfully treated by oral administration and endoscopic injection of Coca-Cola. A 62-year-old woman was referred to Yeungnam University Hospital for epigastric pain. Upper gastrointestinal endoscopy revealed one very large, dark-greenish, solid bezoar in the stomach with gastric ulcer and duodenal bulb deformity. We performed endoscopic injection of Coca-Cola into the bezoar. The patient was instructed to drink four liters of Coca-Cola per day. At endoscopy two days later, the phytobezoar was easily broken into pieces. At endoscopy on the $11^{th}$ day of admission, the phytobezoar was decreased in size and removed by endoscopic fragmentation with a polypectomy snare. At follow up endoscopy after 13 days, the bezoar was completely dissolved.

• Journal of Pharmaceutical Investigation
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• v.21 no.2
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• pp.67-71
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• 1991

A simple and sensitive method was developed for the quantification of free and conjugated bile acids in bezoar without prior hydrolysis. $3{\alpha}-Hydroxy$ bile acids are first oxidized to 3-keto bile acids in the reaction catalyzed by $3{\alpha}-hydroxysteroid$ $dehydrogenase(3{\alpha}-HSD)$. During this oxidative reaction, an equimolar quantity of nicotinamide adenine dinucleotide(NAD) is reduced to NADH and subsequently oxidized to NAD with concomitant reduction of nitrotetrazolium blue(NTB) to diformazan by the catalytic action of diaphorase. The diformazan has an absorbance maximum at 540 nm. The intensity of the color produced is directly proportional to bile acids concentration in the bezoar extracts. The optimum conditions for the enzymatic reaction such as effects of reaction time, reaction temperature and pH, and stability were investigated. Calibration plots for the sodium chelate observed to be linear and intra-, inter-assay analytical recovery of bile acids averaged $97.65{\pm}3.4%(S.D.)$. Therefore, it is considered that the quality control of total bile acids from bezoar or bezoar-containing liquid preparation using this simple and sensitive assay system will be acceptable. Also current bezoars and bezoar-containing liauid preparations were examined their total bile acids from this method.