Phytobezoar as a cause of gastrointestinal obstruction the patient has a gastric resection. Clinical observation

Background. Bezoars, as a cause of high gastrointestinal obstruction, occur in 0.4–4% of cases, with phytobezoars being the most common type. In an intact stomach, phytobezoar formation is practically impossible due to hydrolytic breakdown of plant fibers by hydrochloric acid and pepsin. After gastric resection, a complex of pathophysiological changes develops (hypochlorhydria, impaired motility, loss of the pyloric barrier) that predisposes to bezoar formation.
Aim. To present a clinical case of diospyrobezoar in a patient with a history of gastric resection and to analyze the pathogenetic mechanisms underlying its formation.
Materials and Methods. A 71-year-old female patient with a history of two-thirds gastric resection with a Billroth-I gastroduodenal anastomosis was admitted emergently with signs of high gastrointestinal obstruction (nausea, vomiting after food and water intake, absence of stool). Historytaking revealed persimmon consumption 3 days before symptom onset. Esophagogastroduodenoscopy (EGD) with an attempted endoscopic removal of the bezoar was performed, followed by surgical intervention after the endoscopic approach failed.
Results. EGD revealed a dense, stone-hard phytobezoar occupying the gastric stump lumen with extension into the duodenum; endoscopic removal attempts were unsuccessful. A midline laparotomy and gastrotomy were performed, with evacuation of a foreign body measuring 10.0×5.0 cm. The postoperative course was uneventful, and the patient was discharged in satisfactory condition on postoperative day 14.
Conclusion. Patients with a history of gastric resection constitute a high-risk group for bezoar formation due to impaired hydrolysis and mechanical processing of dietary fiber. Endoscopic removal of large, dense bezoars is not always effective, necessitating timely conversion to surgical treatment.

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