From the Guidelines
Surgical removal of a bezoar is typically performed using an endoscopic approach for bezoars located in the stomach, while bezoars in the small bowel usually require surgical exploration and removal, either by milking the bezoar into the cecum or by enterotomy. The choice of surgical approach depends on the location of the bezoar, with endoscopy being the preferred first-line treatment for stomach bezoars 1. For bezoars located in the small bowel, surgical intervention is required to prevent complications such as obstruction, bleeding, or perforation 1.
Key Considerations
- The location of the bezoar is a critical factor in determining the surgical approach, with stomach bezoars being more amenable to endoscopic removal 1.
- Bezoars in the small bowel require surgical exploration and removal, which can be performed using an open or laparoscopic approach 1.
- The use of medications such as cellulase, papain, or cola beverages may be used to soften the bezoar, making extraction easier 1.
- Patients with bezoars are at risk of developing complications such as obstruction, bleeding, or perforation, which can be life-threatening if not promptly treated 1.
Surgical Approach
- Endoscopic removal is the preferred first-line treatment for stomach bezoars, using a flexible endoscope to break up and extract the bezoar 1.
- For bezoars in the small bowel, surgical exploration and removal is required, which can be performed using an open or laparoscopic approach 1.
- The surgical approach should be tailored to the individual patient's needs, taking into account the location, size, and composition of the bezoar, as well as the patient's overall condition 1.
Post-Operative Care
- Patients who undergo surgical removal of a bezoar typically receive proton pump inhibitors such as omeprazole (20-40mg daily) to reduce gastric acid and promote healing 1.
- Close monitoring is necessary to prevent complications and ensure a smooth recovery 1.
From the Research
Surgical Procedure for Removing a Bezoar
The surgical procedure for removing a bezoar, a mass of swallowed material, can vary depending on the location and size of the bezoar.
- The procedure may involve an exploratory laparotomy, gastrostomy to remove an intra-gastric bezoar, and enterotomy to remove an ileal bezoar, as seen in a case reported by 2.
- Laparoscopic treatment is also a feasible option for bowel obstruction due to a bezoar, as described in a case report by 3, where a Meckel's diverticulum with an impacted phytobezoar was resected and the phytobezoar removed laparoscopically.
- In some cases, a laparoscopic-assisted procedure may be used, where diagnostic laparoscopy confirms the obstruction and a limited abdominal incision allows enterotomy and removal of the obstructing bezoar, as reported by 4.
- Enterolithotomy may also be performed to extract a phytobezoar, as seen in a case reported by 5, where a 6 × 6 cm phytobezoar was extracted from a patient with a history of gastric bypass.
Considerations for Surgical Procedure
- The management of phytobezoar can be either conservative or surgical, depending on the lesion size and location, as noted by 2.
- Abdominal CT-scan is considered the gold standard in the diagnosis of bezoar, due to limitations of endoscopy and barium enema, as stated by 2.
- Nutritional counseling is essential for the follow-up of patients, emphasizing fluid intake and slow chewing, as well as the use of absorbable materials for suture during the surgery, as recommended by 5.