Caleça Emidio Fábio, Pereira Rafaela C, Blanco Saez Rosário, Abegão Teresa, Ribeiro Ana S
Department of Internal Medicine, Centro Hospitalar Universitário do Algarve, Hospital de Faro, Faro, PRT.
Cureus. 2023 Mar 3;15(3):e35726. doi: 10.7759/cureus.35726. eCollection 2023 Mar.
Bezoars are conglomerates of undigested contents that accumulate in the gastrointestinal tract. They can have different compositions, such as fibers, seeds, vegetables (phytobezoars), hair (trichobezoars), and medication (pharmacobezoars). Bezoars are typically caused by an impaired grinding mechanism of the stomach or interdigestive migrating motor complex, but the composition of ingested material can also play a role in their formation. Gastric dysmotility, previous gastric surgery, and gastroparesis are some of the risk factors that can increase the likelihood of developing bezoars. While bezoars are usually asymptomatic and found in the stomach, they can sometimes migrate to the small intestine or colon and cause complications such as intestinal obstruction or perforation. Endoscopy is essential for diagnosis and etiology, and treatment depends on the composition, which can include chemical dissolution or surgical intervention. We present a case of an 86-year-old woman, who had a bezoar located in an unusual location (rectum), most likely due to migration. This condition led to symptoms of intermittent intestinal obstruction and rectal bleeding. However, due to anal stenosis, the patient was unable to expel the bezoar. Its removal was not possible through various endoscopic techniques. Therefore, it was removed via fragmentation, using an anoscope and forceps, due to its hard/stone-like consistency. This case highlights the importance of considering bezoars in the differential diagnosis of gastrointestinal bleeding and illustrates the importance of prompt diagnosis and appropriate techniques for the removal of bezoars.
胃石是在胃肠道中积聚的未消化内容物的聚集体。它们可以有不同的成分，如纤维、种子、蔬菜（植物性胃石）、毛发（毛发性胃石）和药物（药物性胃石）。胃石通常是由胃的研磨机制受损或消化间期移行性复合运动障碍引起的，但摄入物质的成分在其形成过程中也可能起作用。胃动力障碍、既往胃部手术和胃轻瘫是一些可增加发生胃石可能性的危险因素。虽然胃石通常无症状且位于胃内，但它们有时会迁移至小肠或结肠并引起肠梗阻或穿孔等并发症。内镜检查对于诊断和病因诊断至关重要，治疗取决于其成分，可包括化学溶解或手术干预。我们报告一例86岁女性病例，其胃石位于一个不寻常的部位（直肠），很可能是由于迁移所致。这种情况导致了间歇性肠梗阻和直肠出血的症状。然而，由于肛门狭窄，患者无法排出胃石。通过各种内镜技术无法将其取出。因此，由于其质地坚硬/类似石头，使用肛门镜和镊子通过破碎将其取出。该病例强调了在胃肠道出血的鉴别诊断中考虑胃石的重要性，并说明了及时诊断和采用适当技术取出胃石的重要性。
