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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 gastrointestinal (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. Castle SL et al: Management of complicated gastric bezoars in children and adolescents. Isr Med Assoc J. 17(9):541-4, 2015
                                  2. 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
                                  3. Iwamuro M et al: Review of the diagnosis and management of gastrointestinal bezoars. World J Gastrointest Endosc. 7(4):336-45, 2015
                                  4. Lee KH et al: Ultrasonographic differentiation of bezoar from feces in small bowel obstruction. Ultrasonography. 34(3):211-6, 2015
                                  5. Park SE et al: Clinical outcomes associated with treatment modalities for gastrointestinal bezoars. Gut Liver. 8(4):400-7, 2014
                                  6. Fallon SC et al: The surgical management of Rapunzel syndrome: a case series and literature review. J Pediatr Surg. 48(4):830-4, 2013
                                  7. Heinz-Erian P et al: Gastric lactobezoar - a rare disorder? Orphanet J Rare Dis. 7:3, 2012
                                  8. Kim HC et al: Color Doppler twinkling artifacts in small-bowel bezoars. J Ultrasound Med. 31(5):793-7, 2012
                                  9. Gorter RR et al: Management of trichobezoar: case report and literature review. Pediatr Surg Int. 26(5):457-63, 2010
                                  10. Hewitt AN et al: Gastric bezoars: reassessment of clinical and radiographic findings in 19 patients. Br J Radiol. 82(983):901-7, 2009
                                  11. Delabrousse E et al: Small-bowel bezoar versus small-bowel feces: CT evaluation. AJR Am J Roentgenol. 191(5):1465-8, 2008
                                  12. Erzurumlu K et al: Gastrointestinal bezoars: a retrospective analysis of 34 cases. World J Gastroenterol. 11(12):1813-7, 2005
                                  13. Zamir D et al: Phytobezoars and trichobezoars: a 10-year experience. J Clin Gastroenterol. 38(10):873-6, 2004
                                  14. Ripoll├ęs T et al: Gastrointestinal bezoars: sonographic and CT characteristics. AJR Am J Roentgenol. 177(1):65-9, 2001
                                  15. Gayer G et al: Bezoars in the stomach and small bowel--CT appearance. Clin Radiol. 54(4):228-32, 1999
                                  16. Newman B et al: Gastric trichobezoars--sonographic and computed tomographic appearance. Pediatr Radiol. 20(7):526-7, 1990
                                  17. 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 gastrointestinal (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. Castle SL et al: Management of complicated gastric bezoars in children and adolescents. Isr Med Assoc J. 17(9):541-4, 2015
                                                                  2. 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
                                                                  3. Iwamuro M et al: Review of the diagnosis and management of gastrointestinal bezoars. World J Gastrointest Endosc. 7(4):336-45, 2015
                                                                  4. Lee KH et al: Ultrasonographic differentiation of bezoar from feces in small bowel obstruction. Ultrasonography. 34(3):211-6, 2015
                                                                  5. Park SE et al: Clinical outcomes associated with treatment modalities for gastrointestinal bezoars. Gut Liver. 8(4):400-7, 2014
                                                                  6. Fallon SC et al: The surgical management of Rapunzel syndrome: a case series and literature review. J Pediatr Surg. 48(4):830-4, 2013
                                                                  7. Heinz-Erian P et al: Gastric lactobezoar - a rare disorder? Orphanet J Rare Dis. 7:3, 2012
                                                                  8. Kim HC et al: Color Doppler twinkling artifacts in small-bowel bezoars. J Ultrasound Med. 31(5):793-7, 2012
                                                                  9. Gorter RR et al: Management of trichobezoar: case report and literature review. Pediatr Surg Int. 26(5):457-63, 2010
                                                                  10. Hewitt AN et al: Gastric bezoars: reassessment of clinical and radiographic findings in 19 patients. Br J Radiol. 82(983):901-7, 2009
                                                                  11. Delabrousse E et al: Small-bowel bezoar versus small-bowel feces: CT evaluation. AJR Am J Roentgenol. 191(5):1465-8, 2008
                                                                  12. Erzurumlu K et al: Gastrointestinal bezoars: a retrospective analysis of 34 cases. World J Gastroenterol. 11(12):1813-7, 2005
                                                                  13. Zamir D et al: Phytobezoars and trichobezoars: a 10-year experience. J Clin Gastroenterol. 38(10):873-6, 2004
                                                                  14. Ripoll├ęs T et al: Gastrointestinal bezoars: sonographic and CT characteristics. AJR Am J Roentgenol. 177(1):65-9, 2001
                                                                  15. Gayer G et al: Bezoars in the stomach and small bowel--CT appearance. Clin Radiol. 54(4):228-32, 1999
                                                                  16. Newman B et al: Gastric trichobezoars--sonographic and computed tomographic appearance. Pediatr Radiol. 20(7):526-7, 1990
                                                                  17. Verstandig AG et al: Small bowel phytobezoars: detection with radiography. Radiology. 172(3):705-7, 1989