AIM: Bezoars (BZ) are the most common foreign bodies of gastrointestinal tract. Clinical manifestations vary depending on the location of BZ from no symptoms to acute abdominal syndrome. When located in small bowel, they frequently cause small bowel obstruction (SBO). We aimed to present our experience by reviewing literature.

METHODS: Thirty-four patients with gastrointestinal BZ were presented. The data were collected from hospital records and analyzed retrospectively. Morbidity and mortality rates were statistically analyzed between the subgroups according to SBO and endoscopic or surgical treatment modalities.

RESULTS: The 34 patients had phytobezoars (PBZ). Two patients with mental retardation and trichotillomania had trichobezoars (TBZ). More than half of them (55.88%) had previous gastric surgery. Also most of them had small bowel bezoars resulting in obstruction. Surgical and endoscopic morbidity rates were 32.14% and 14.28% respectively. The total morbidity rate of this study was 29.41%. Four patients in surgically treated group died. There was no death in endoscopically treated group. The total and surgical mortality rates were 11.76% and 14.28% respectively. The differences in morbidity and mortality rates between the subgroups were not statistically significant.

CONCLUSION: BZ are commonly seen in stomach and small intestine. SBO is the most common complication. When uncomplicated, endoscopic or surgical removal can be applied easily.

Gastrointestinal bezoars: a retrospective analysis of 34 cases.

High-resolution real-time ultrasonography (US) serves as an important tool for differentiation of obstructive and nonobstructive causes of jaundice in infants and children, independent of liver function. Unconjugated hyperbilirubinemia occurs in approximately 60% of normal term infants and in 80% of preterm infants. Persistence of neonatal jaundice beyond 2 weeks of age demands US evaluation to differentiate between the three most common causes: hepatitis, biliary atresia, and choledochal cyst. In all three conditions, the hepatic echotexture is diffusely coarse and hyperechoic, but this appearance may be seen in a variety of hepatic inflammatory, obstructive, and metabolic processes. Thus, hepatic scintigraphy and at times percutaneous liver biopsy are necessary to narrow the differential diagnosis and to identify patients who require more invasive techniques (eg, intraoperative cholangiography). US is useful for demonstrating inspissated bile and biliary duct stones. In infants, stones are usually secon...

US Approach to Jaundice in Infants and Children

Bezoars in the stomach and small bowel — CT appearance

Simultaneous gastric and small intestinal trichobezoars--a hairy problem.

Like other cross-sectional imaging methods, transabdominal sonography is increasingly used for evaluation of gastrointestinal diseases. The potentials and limitations of sonography in evaluation of the gastrointestinal tract are discussed. Transabdominal sonography proved to be of clinical value in assessment of appendicitis, diverticulitis, bowel obstruction, chronic inflammatory bowel diseases, intussusception and infantile hypertrophic pyloric stenosis. The sonographic morphology of the most common gastrointestinal diseases is discussed. In experienced hands sonography can be used as primary imaging in several gastrointestinal diseases. The gastrointestinal tract should be included in the sonographic examination of the abdomen, especially if symptoms could be related to the intestine.

Transabdominal sonography of the gastrointestinal tract

Ultrasonographic diagnosis of trichobezoar may be relatively specific. A broad band of high-amplitude echoes can be seen superficially, with complete sonic shadowing behind. The authors describe a patient in whom the diagnosis was made prior to conventional barium studies and in whom the question of trichobezoar had not been raised clinically.

Gastric trichobezoar: sonographic findings.

The sonograms of 12 neonates and infants with documented nonneoplastic parenchymal liver diseases, including cytomegalovirus infection, biliary atresia, alpha 1-antitrypsin deficiency, nesidioblastosis, Alagille association, microabscesses, and idiopathic neonatal jaundice, were analyzed by various sonographic criteria. Nine (75%) of the hepatic sonograms were abnormal; however, most showed only one sonographic abnormality. Although it was not possible to distinguish one condition from another sonographically, focal areas of heterogeneity simulating mass lesions and accentuated periportal brightness were the most notable abnormal features. The prime indication for hepatic sonography in this age group continues to be the differentiation of obstructive from nonobstructive jaundice. Nonetheless, when obstruction has been excluded, sonography may demonstrate the presence of hepatic parenchymal disease and provide a noninvasive means for following its course over time.

Sonographic features of hepatocellular disease in neonates and infants

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Gastric trichobezoar: sonographic findings.

Sonographic features of hepatocellular disease in neonates and infants