Artigo Revisado por pares

An Unusual Case of a Bleeding Gastric Ulcer Due to Multiple Phytobezoars Consisting of Peach Pits: A Case Report and Review

2011; Lippincott Williams & Wilkins; Volume: 106; Linguagem: Inglês

10.14309/00000434-201110002-00500

ISSN

1572-0241

Autores

Derrick Cheung, Ava Anklesaria, Pavel Gozenput, Rabin Rahmani, K. Iswara, Jianjun Li, Nisson Badalov,

Tópico(s)

Intestinal and Peritoneal Adhesions

Resumo

Purpose: Gastric bezoars consist of foreign ingested material that accumulates within the GI tract. We are reporting an unusual type of bezoar presenting as abdominal pain and severe chronic iron deficiency anemia who was found to have a bleeding gastric ulcer due to multiple phytobezoars consisting of peach pits. A 43 year old male with a past medical history of mental retardation presented with three years of intermittent abdominal pain and subjective weight loss. He had no prior surgeries and had a recent normal colonoscopy. He denied any melena or hematochezia. On physical exam, he was found to have mild LUQ tenderness. Routine blood work was significant for hemoglobin of 6.6 g/dL, a hematocrit of 22.1% and an MCV of 60.2 FL. A CT scan of the abdomen showed multiple unidentifiable structures in the stomach measuring ˜2-3 cms. An endoscopy was performed which showed multiple peach pits in the stomach causing a large, bleeding gastric ulcer and multiple small linear ulcers (image). The peach pits were removed and the patient was managed with PPIs and diet education. The patient later admitted to eating numerous peaches and their pits everyday. Bezoars grow by the continued consumption of indigestible materials clumped together by protein, mucus, and pectin. Phytobezoars are the most common type of bezoar and consist of material such as cellulose, hemicellulose, tannins and lignin. Common predisposing factors for bezoar formation include previous gastric surgery or vagotomy and motility disorders. The most common complaints are nonspecific abdominal pain, nausea, vomiting, and weight loss. Major complications include small bowel obstruction, ulcers, gastric perforations and bleeding. Imaging used to diagnose bezoars includes abdominal radiographs, abdominal ultrasounds and CT scans which may show a mass or filling defect. Endoscopy remains the modality of choice for the diagnosis of bezoars. Occasionally, bezoars can be treated with chemical dissolution but larger bezoars may require endoscopic fragmentation and retrieval. Surgery should be considered in patients who fail medical therapy. This patient demonstrated a rare presentation of multiple phytobezoars in the stomach causing a gastric ulcer due to the abrasive nature of the pits which led to severe anemia. After a detailed literature search, this was the first reported case of peach pits causing a large bleeding gastric ulcer and severe anemia.Figure

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