Wang Ting-Ting, He Jia-Jun, Liu Jun, Chen Wei-Wei, Chen Chao-Wu
Department of Gastroenterology, The First Clinical Medical College, Dalian Medical University, Dalian 116044, Liaoning Province, China.
Endoscopy Center, Department of Gastroenterology, Clinical Medical College, Yangzhou University, Yangzhou 225009, Jiangsu Province, China.
World J Clin Cases. 2021 May 6;9(13):3114-3119. doi: 10.12998/wjcc.v9.i13.3114.
Bezoars are conglomerates of indigestible foreign material that can be found in the gastrointestinal tract. Gastric ulcer, gastrointestinal perforation, and intestinal obstruction are the main complications. Acute pancreatitis secondary to bezoar is rare. Here, we present a rare case of a migratory gastric bezoar complicated by acute pancreatitis and small bowel obstruction after dissolution therapy.
A-65-year-old woman underwent gastroscopy because of epigastric pain, which revealed a huge bezoar and a gastric ulcer 10 d prior. The patient was discharged with a prescription of drinking 1 L Coca-Cola daily for 6 d, without repeat gastroscopy. However, she suddenly developed epigastric pain, nausea and vomiting for 3 d. Abdominal computed tomography (CT) revealed mild inflammation of the pancreas. Magnetic resonance cholangiopancreatography showed no abnormalities in the pancreatic duct or common bile duct. The nasogastric tube still showed drainage of more than 1.6 L of dark fluid each day after symptomatic treatment. Abdominal CT re-examination suggested intestinal obstruction. Esophagogastroduodenoscopy revealed a huge yellowish hard mass in the jejunal lumen, and we used the basket and net to fragment the bezoar. She was discharged with a good outcome.
Endoscopic therapy is the first choice for gastric bezoars. When mechanical disintegration cannot be achieved, timing of repeat endoscopy is important during Coca-Cola dissolution therapy.
胃石是在胃肠道中发现的难消化异物的聚集体。胃溃疡、胃肠道穿孔和肠梗阻是主要并发症。胃石继发急性胰腺炎罕见。在此，我们报告一例罕见的游走性胃石病例，该病例在溶解治疗后并发急性胰腺炎和小肠梗阻。
一名65岁女性因上腹部疼痛接受胃镜检查，10天前胃镜检查发现巨大胃石和胃溃疡。患者出院时开具了每日饮用1升可口可乐，共6天的处方，未进行重复胃镜检查。然而，她突然出现上腹部疼痛、恶心和呕吐3天。腹部计算机断层扫描（CT）显示胰腺轻度炎症。磁共振胰胆管造影显示胰管和胆总管无异常。对症治疗后，鼻胃管每天仍引流出超过1.6升深色液体。腹部CT复查提示肠梗阻。食管胃十二指肠镜检查发现空肠腔内有一个巨大的淡黄色硬块，我们用网篮将胃石破碎。她出院时情况良好。
内镜治疗是胃石的首选治疗方法。当无法进行机械破碎时，在可口可乐溶解治疗期间，重复内镜检查的时机很重要。
