Honda Hirokazu, Ikeya Takashi, Kashiwagi Erika, Okada Shuichi, Fukuda Katsuyuki
Division of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan.
Case Rep Gastroenterol. 2017 Nov 29;11(3):718-723. doi: 10.1159/000484130. eCollection 2017 Sep-Dec.
Gastric bezoars are rare and are usually found incidentally. They can sometimes cause severe complications, including gastric outlet obstruction (GOO) or gastric pneumatosis (GP). In cases of bezoars with GP, the optimal treatment strategy has not yet been defined. We report the case of an 89-year-old man with a history of type 2 diabetes mellitus and hypertension who presented to our emergency room with a 2-day history of upper abdominal pain, nausea, and vomiting. Physical examination revealed no rebound tenderness or guarding, and laboratory values revealed no elevation of the serum lactate level. A computed tomography scan of the abdomen showed a dilated stomach with significant fluid collection, GOO, and GP due to a 42 × 40 mm mass composed of fat and air densities. Emergency esophagogastroduodenoscopy revealed two gastric bezoars, one of which was incarcerated in the pyloric region. We used various endoscopic devices to successfully break and remove the bezoars. We used endoscopic forceps and a water jet followed by an endoscopic snare to cut the bezoars into several pieces and remove them with an endoscopic net. Follow-up endoscopy confirmed that the gastric bezoar had been completely removed. As seen in this case, endoscopic treatment may be a safe and viable option for the extraction of gastric bezoars presenting with GOO and GP.
胃石症较为罕见，通常是偶然发现。它们有时会引发严重并发症，包括胃出口梗阻（GOO）或胃积气症（GP）。对于伴有GP的胃石症病例，最佳治疗策略尚未明确。我们报告一例89岁男性病例，该患者有2型糖尿病和高血压病史，因上腹部疼痛、恶心和呕吐2天前来我院急诊室就诊。体格检查未发现反跳痛或肌紧张，实验室检查结果显示血清乳酸水平未升高。腹部计算机断层扫描显示胃扩张，伴有大量积液、GOO以及因一个由脂肪和气体密度组成的42×40 mm肿块导致的GP。急诊食管胃十二指肠镜检查发现两个胃石，其中一个嵌顿在幽门区域。我们使用了各种内镜设备成功地破碎并取出了胃石。我们先用内镜钳和水刀，然后用内镜圈套器将胃石切成数块，并用内镜网取出。随访内镜检查证实胃石已被完全取出。如本病例所示，内镜治疗对于伴有GOO和GP的胃石症的取出可能是一种安全可行的选择。
