Gastric Bezoar

 Phytobezoar: Undigested vegetable matter

– Persimmons contain tannin, which coagulates on contact with gastric acid

image Trichobezoars: Accumulated, matted mass of hair
– Most common in young girls

image Lactobezoar: Undigested milk concretions (infants)

image Pharmacobezoar: Bezoar composed of medications



• Mobile intraluminal gastric filling defect

• “Mottled” appearance is result of air bubbles retained in interstices of mass

• Large bezoars may fill and take shape of stomach

• Small bezoars are rounded or ovoid
image Tend to float on water-air surface surrounded by gastric contents


• Predisposing causes
image Previous gastric surgery: Vagotomy, pyloroplasty, antrectomy, partial gastrectomy

image Inadequate chewing, missing teeth, dentures

image Overindulgence in foods with high fiber content

image Altered gastric motility: Diabetes, mixed connective tissue disease, hypothyroidism


• Bezoars usually form in stomach
image May fragment and enter small bowel where they absorb water, increase in size, and become impacted

image May present with small-bowel obstruction

• Drinking several liters of cola beverage has been reported to clear all or portions of phytobezoars

• Symptomatic, large phytobezoars or trichobezoars require endoscopic fragmentation or surgical removal
image Spontaneous expulsion of bezoar is uncommon

(Left) Film from an upper GI series in a 60-year-old man with early satiety years after vagotomy and Billroth 1 surgery shows evidence of the prior surgery and a large heterogeneous “ball” of debris and gas within the stomach mixed with the barium.

(Right) Axial CECT shows a laminated mass image in the stomach due to a phytobezoar.

(Left) Upper GI series in a 3-year-old girl with vomiting shows a fixed filling defect in the stomach with a swirled pattern of gas and solid material found to represent a trichobezoar.

(Right) A film from a small bowel follow-through shows evidence of a prior Billroth II partial gastrectomy and complete obstruction of antegrade flow of barium in the mid jejunum. At surgery, a phytobezoar was removed, which corresponded to the shape and size of the gastric remnant.



• Intragastric mass composed of accumulated ingested (but not digested) material


General Features

• Best diagnostic clue
image CT or fluoroscopy: Intraluminal mass containing mottled air pattern

• Location
image Sites of impaction: Stomach, jejunum, ileum
– Narrowest portion of small bowel 50-75 cm from ileocecal valve or valve itself

– Any part can be affected, especially in patients with postoperative adhesions

• Morphology
image Large bezoars fill and take shape of stomach

Radiographic Findings

• Radiography
image Abdominal plain film: Soft tissue mass floating in stomach at air-fluid interface
– Mottled radiotransparencies in interstices of solid matter

– ± bowel obstruction

image Insensitive test; bezoar identified in only 10-18% of patients from radiographs alone

Fluoroscopic Findings

• Intraluminal filling defect
image With finely lobulated, villous-like surface

image Freely mobile, without constant site of attachment to bowel wall

• Barium outlines bezoar
image “Mottled” or streaked appearance; contrast medium entering interstices of bezoar

• Filling defect may occasionally appear completely smooth
image Could be mistaken for enormous gas bubble that is freely movable within stomach

• Coiled spring appearance (rare)

• Partial or complete small bowel obstruction
image Try to distinguish obstruction due to postoperative adhesions from bezoar-induced obstruction

CT Findings

• Well-defined, oval, low-density, intraluminal mass
image “Mottled” appearance of mass is due to air bubbles retained in interstices of mass

image Heterogeneous mass without postcontrast enhancement
– Pockets of gas, debris, fluid scattered throughout

– No air-fluid level within lesion

• Large bezoars tend to fill lumen

• Small bezoars are rounded or ovoid; tend to float on water-air surface surrounded by gastric contents
image Oral contrast material may be seen surrounding mass, establishing free intraluminal location

• Bezoar may have “laminated” appearance

Ultrasonographic Findings

• Intraluminal mass with hyperechoic arc-like surface
image With marked acoustic shadowing

• Identification of additional intestinal or gastric bezoars may be difficult

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Nov 16, 2016 | Posted by in GASTROINTESTINAL IMAGING | Comments Off on Gastric Bezoar
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