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Bezoars
Michael R. Aquino, MD, MHSc
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Definitions

          • Specific ingested materials accumulate to form indigestible & potentially obstructive mass in GI tract
          • Classified based on ingested material, including
            • Trichobezoar: Hair
            • Phytobezoar: Indigestible food components, typically vegetable or fruit fibers
            • Lactobezoar: Concretion of coagulated milk & mucous proteins
          • Rapunzel syndrome: Gastric trichobezoar that extends distally through pylorus

        IMAGING

        • Radiographic Findings

          • Fluoroscopic Findings

            • Ultrasonographic Findings

              • CT Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      CLINICAL ISSUES

                      • Presentation

                        • Demographics

                          • Natural History & Prognosis

                            • Treatment

                              DIAGNOSTIC CHECKLIST

                              • Consider

                                • Image Interpretation Pearls

                                  Selected References

                                  1. Shah M et al: Gastric bezoar: retrieve it, leave it, or disbelieve it? J Pediatr Gastroenterol Nutr. 72(2):e31-6, 2021
                                  2. Soon YQA et al: Clinics in diagnostic imaging (198). Small bowel obstruction secondary to a bezoar. Singapore Med J. 60(8):397-402, 2019
                                  3. García-Ramírez BE et al: Small-bowel obstruction secondary to ileal trichobezoar in a patient with Rapunzel syndrome. Case Rep Gastroenterol. 12(3):559-65, 2018
                                  4. Lalith S et al: Rapunzel syndrome. J Clin Diagn Res. 11(9):TD01-2, 2017
                                  5. Marilina D et al: A non-occlusive bezoar of caecum in a 7-year-old child: ultrasound detection and multimodality imaging management. J Ultrasound. 19(3):223-6, 2016
                                  6. Castle SL et al: Management of complicated gastric bezoars in children and adolescents. Isr Med Assoc J. 17(9):541-4, 2015
                                  7. Chen YC et al: Imaging differentiation of phytobezoar and small-bowel faeces: CT characteristics with quantitative analysis in patients with small- bowel obstruction. Eur Radiol. 25(4):922-31, 2015
                                  8. Iwamuro M et al: Review of the diagnosis and management of gastrointestinal bezoars. World J Gastrointest Endosc. 7(4):336-45, 2015
                                  9. Lee KH et al: Ultrasonographic differentiation of bezoar from feces in small bowel obstruction. Ultrasonography. 34(3):211-6, 2015
                                  10. Park SE et al: Clinical outcomes associated with treatment modalities for gastrointestinal bezoars. Gut Liver. 8(4):400-7, 2014
                                  11. Fallon SC et al: The surgical management of Rapunzel syndrome: a case series and literature review. J Pediatr Surg. 48(4):830-4, 2013
                                  12. Kim HC et al: Color Doppler twinkling artifacts in small-bowel bezoars. J Ultrasound Med. 31(5):793-7, 2012
                                  13. Gorter RR et al: Management of trichobezoar: case report and literature review. Pediatr Surg Int. 26(5):457-63, 2010
                                  14. Hewitt AN et al: Gastric bezoars: reassessment of clinical and radiographic findings in 19 patients. Br J Radiol. 82(983):901-7, 2009
                                  15. Delabrousse E et al: Small-bowel bezoar versus small-bowel feces: CT evaluation. AJR Am J Roentgenol. 191(5):1465-8, 2008
                                  16. Ripollés T et al: Gastrointestinal bezoars: sonographic and CT characteristics. AJR Am J Roentgenol. 177(1):65-9, 2001
                                  17. Gayer G et al: Bezoars in the stomach and small bowel--CT appearance. Clin Radiol. 54(4):228-32, 1999
                                  18. Newman B et al: Gastric trichobezoars--sonographic and computed tomographic appearance. Pediatr Radiol. 20(7):526-7, 1990
                                  19. Verstandig AG et al: Small bowel phytobezoars: detection with radiography. Radiology. 172(3):705-7, 1989
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Clinical Issues

                                        TERMINOLOGY

                                        • Definitions

                                          • Specific ingested materials accumulate to form indigestible & potentially obstructive mass in GI tract
                                          • Classified based on ingested material, including
                                            • Trichobezoar: Hair
                                            • Phytobezoar: Indigestible food components, typically vegetable or fruit fibers
                                            • Lactobezoar: Concretion of coagulated milk & mucous proteins
                                          • Rapunzel syndrome: Gastric trichobezoar that extends distally through pylorus

                                        IMAGING

                                        • Radiographic Findings

                                          • Fluoroscopic Findings

                                            • Ultrasonographic Findings

                                              • CT Findings

                                                • Imaging Recommendations

                                                  DIFFERENTIAL DIAGNOSIS

                                                    PATHOLOGY

                                                    • General Features

                                                      CLINICAL ISSUES

                                                      • Presentation

                                                        • Demographics

                                                          • Natural History & Prognosis

                                                            • Treatment

                                                              DIAGNOSTIC CHECKLIST

                                                              • Consider

                                                                • Image Interpretation Pearls

                                                                  Selected References

                                                                  1. Shah M et al: Gastric bezoar: retrieve it, leave it, or disbelieve it? J Pediatr Gastroenterol Nutr. 72(2):e31-6, 2021
                                                                  2. Soon YQA et al: Clinics in diagnostic imaging (198). Small bowel obstruction secondary to a bezoar. Singapore Med J. 60(8):397-402, 2019
                                                                  3. García-Ramírez BE et al: Small-bowel obstruction secondary to ileal trichobezoar in a patient with Rapunzel syndrome. Case Rep Gastroenterol. 12(3):559-65, 2018
                                                                  4. Lalith S et al: Rapunzel syndrome. J Clin Diagn Res. 11(9):TD01-2, 2017
                                                                  5. Marilina D et al: A non-occlusive bezoar of caecum in a 7-year-old child: ultrasound detection and multimodality imaging management. J Ultrasound. 19(3):223-6, 2016
                                                                  6. Castle SL et al: Management of complicated gastric bezoars in children and adolescents. Isr Med Assoc J. 17(9):541-4, 2015
                                                                  7. Chen YC et al: Imaging differentiation of phytobezoar and small-bowel faeces: CT characteristics with quantitative analysis in patients with small- bowel obstruction. Eur Radiol. 25(4):922-31, 2015
                                                                  8. Iwamuro M et al: Review of the diagnosis and management of gastrointestinal bezoars. World J Gastrointest Endosc. 7(4):336-45, 2015
                                                                  9. Lee KH et al: Ultrasonographic differentiation of bezoar from feces in small bowel obstruction. Ultrasonography. 34(3):211-6, 2015
                                                                  10. Park SE et al: Clinical outcomes associated with treatment modalities for gastrointestinal bezoars. Gut Liver. 8(4):400-7, 2014
                                                                  11. Fallon SC et al: The surgical management of Rapunzel syndrome: a case series and literature review. J Pediatr Surg. 48(4):830-4, 2013
                                                                  12. Kim HC et al: Color Doppler twinkling artifacts in small-bowel bezoars. J Ultrasound Med. 31(5):793-7, 2012
                                                                  13. Gorter RR et al: Management of trichobezoar: case report and literature review. Pediatr Surg Int. 26(5):457-63, 2010
                                                                  14. Hewitt AN et al: Gastric bezoars: reassessment of clinical and radiographic findings in 19 patients. Br J Radiol. 82(983):901-7, 2009
                                                                  15. Delabrousse E et al: Small-bowel bezoar versus small-bowel feces: CT evaluation. AJR Am J Roentgenol. 191(5):1465-8, 2008
                                                                  16. Ripollés T et al: Gastrointestinal bezoars: sonographic and CT characteristics. AJR Am J Roentgenol. 177(1):65-9, 2001
                                                                  17. Gayer G et al: Bezoars in the stomach and small bowel--CT appearance. Clin Radiol. 54(4):228-32, 1999
                                                                  18. Newman B et al: Gastric trichobezoars--sonographic and computed tomographic appearance. Pediatr Radiol. 20(7):526-7, 1990
                                                                  19. Verstandig AG et al: Small bowel phytobezoars: detection with radiography. Radiology. 172(3):705-7, 1989