Bezoar

Background

• Mass within the gastrointestinal system
• Made up of organic or inorganic material
• Commonly from eating hair or indigestible materials
• Risk factors include intellectual disability or emotional disturbance
• More common females aged 10 to 19 years of age

Types of Bezoars

• Food boluses
• Lactobezoar (seen in premature infants receiving formula)
• Pharmacobezoars (medications, especially overdoses of sustained-release medications
• Phytobezoars (indigestible plant material)
• Trichobezoar (hair)

Clinical Features

• Indigestion
• Abdominal pain
• Nausea and vomiting
• Diarrhea
• Gastric ulcers

Differential Diagnosis

Epigastric Pain

• Gastroesophageal reflux disease (GERD)
• Peptic ulcer disease with or without perforation
• Gastritis
• Pancreatitis
• Gallbladder disease
  • Acute cholecystitis
  • Cholangitis
  • Symptomatic cholelithiasis
  • Acalculous cholecystitis
• Myocardial Ischemia
• Splenic Infarctionenlargement/rupture/aneurysm
• Pericarditis/Myocarditis
• Aortic dissection
• Hepatitis
• Pyelonephritis
• Pneumonia
• Pyogenic liver abscess
• Fitz-Hugh-Curtis Syndrome
• Hepatomegaly due to CHF
• Bowel obstruction
• SMA syndrome
• Pulmonary embolism
• Bezoar
• See Nausea and vomiting

Management

• Removal either endoscopically if small but may require surgical removal when large

References

Authors

Meagan Mackey, Michael O'Brien, MD, Ross Donaldson