myra lalas pitt. 1. no direct ct evidence of appendicitis. 2. gastric bezoar versus foodstuff within...

Myra Lalas Pitt

1. NO  DIRECT  CT  EVIDENCE  OF 

APPENDICITIS.

2.  GASTRIC  BEZOAR  VERSUS 

FOODSTUFF  WITHIN  THE  STOMACH.

3.    RIGHT-SIDED  ADNEXAL  CYST  WITH  FREE 

FLUID  IN  CUL  DE  SAC  CONSISTENT  WITH  CYST  RUPTURE.

4.    TRACE  AMOUNT  OF  PERIPORTAL 

EDEMA.    ULTRASOUND  MAY  BE 

OBTAINED 

IF  CLINICALLY  INDICATED.

5.    FECAL  MATERIAL  THROUGHOUT  THE  ENTIRE  COLON  CONSISTENT  WITH  CONSTIPATION.

Definition Result from the accumulation of foreign

ingested material in the form of masses or concretions

Rare and occurs in <1% of the population

Grow by the continuing intake of food rich in cellulose and other indigestible materials such as hair, cotton, and tissue paper, matted together by protein, mucus, and pectin.

Pathophysiology

Properties of the ingested material and some degree of gastric dysfunction may lead to its formation

Risk Factors:

Previous gastric surgery

Delayed gastric emptying

Signs and Symptoms Phytobezoars: men in their 40s-50s Trichobezoars: women in their 20s Symptoms usually develop insidiously:Abominal painNausea/ vomitingEarly satietyAnorexiaWeight lossGI bleeding

Diagnosis

AXR:

CT Scan

Gastric trichobezoar

Treatment

Depend on their composition, location and size.

Dissolution therapy (cellulase, acetylcystein, papain and Coca Cola)

Endoscopic fragmentation and/or aspiration

Surgery

Endoscopic removal of the yellow-greenish-colored bezoar and normal gastric mucosa.

Gastric bezoar dissolution with oral Coca-Cola® intake

Sara Regaño, Marisol Trugeda, Gonzalo Gutierrez, Susana Menéndez and Gonzalo De las Heras, 05 May 2009

Lavage with Coca-Cola® as a safe and effective treatment for gastric bezoars was first described in 2002

Case of 64 yo F with hypogastric pain & gastric fullness for 3 years; h/o DM type 2 and hyperthyroidism

Meds: Omeprazol®, plus oral antidiabetic agents, and Thirodril

The patient was asked to drink 3 cans of Coca-Cola® per day with every meal (33 cl. 3 times a day) for a month.

The mechanism of Coca-Cola® dissolution is not fully explained.

Phosphoric acid (H3PO4) is responsible for Coke’s pH of 2.6, which is close to the pH of gastric secretions→ acidification of the gastric content may be the way Coca-Cola® acts by disintegrating the bezoar.

The release of carbon dioxide (CO2) bubbles into the gastric lumen and the mucolitic action of sodium bicarbonate (NaHCO3) may also contribute to bezoar dissolution.

References

Azevedo et al. Successful endoscopic resolution of a large gastric

bezoar in a child. World J Gastrointest Endosc. 2011 June 16; 3(6):

129–132.

Regano et al. Gastric bezoar dissolution with oral Coca-Cola®

intake. May 2009 (www.gastrohep.com)

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