Gastric Bezoar After Vagotomy and Billroth I Resection Presenting With Gastric Outlet Obstruction

Abstract

Bezoars are collections of undigested materials that can accumulate in any part of the gastrointestinal (GI) tract with the stomach being the most frequent location. They could occur as a complication of gastric surgery, which creates a low acid environment, decreased peristalsis, and abnormal pyloric function. Vagotomy and Billroth resections are culprit surgeries even decades after the procedure. The clinical presentation varies from asymptomatic, a vague feeling of epigastric discomfort and bloating to gastric ulcerations from pressure necrosis and subsequent GI bleeding, or gastric outlet obstruction. Endoscopy is not only the diagnostic test of choice but also has the advantage of offering therapeutic interventions like fragmentation or dissolution. When conservative treatments and endoscopic approaches fail, surgical extraction is recommended. We describe a patient with a gastric bezoar 25 years after vagotomy and Billroth I in which the diagnosis was delayed due to atypical presentation.




J Med Cases. 2016;7(1):1-4
doi: http://dx.doi.org/10.14740/jmc2310w