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Gastric bezoars: reassessment of clinical and radiographic findings in 19 patients

Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

View larger version (64K): [in this window] [in a new window]   Figure 1. A 21-year-old woman with a giant gastric bezoar. (a) A frontal spot image from a single-contrast upper gastrointestinal tract examination shows the bezoar as a mottled mass (large arrows) that conforms to the gastric wall, filling virtually the entire stomach. Note the presence of a small hiatal hernia (small arrows). Marked gastroparesis was observed at fluoroscopy. (b) An unenhanced axial CT image shows an inhomogeneous mass (arrows) in the stomach containing areas of soft tissue density intermixed with multiple tiny bubbles of gas. This patient presented with nausea and vomiting that improved on dietary restriction. Follow-up CT 30 days after the original barium study showed resolution of the bezoar.

View larger version (68K): [in this window] [in a new window]   Figure 2. A 59-year-old woman with a gastric bezoar. (a) A steep left posterior oblique spot image from a double-contrast upper gastrointestinal tract examination shows an ovoid, relatively homogeneous mass (arrows) in the stomach, floating in the barium pool. Gastroparesis was observed at fluoroscopy. The bezoar was also detected at endoscopy 2 days before the barium study. (b) An intravenous enhanced axial CT image shows a heterogeneous mass (arrows) in the stomach containing soft-tissue of varying density, intermixed with oral contrast material and tiny bubbles of gas. This patient presented with nausea, vomiting and abdominal pain that improved after endoscopic suction of the bezoar and treatment with a liquid diet and metoclopramide.

View larger version (160K): [in this window] [in a new window]   Figure 3. A 60-year-old woman with a gastric bezoar after an oesophagogastrectomy, gastric pull-through and vagotomy. A left posterior oblique spot image from a single-contrast upper gastrointestinal tract examination shows an ovoid, homogeneous mass (black arrows) floating in the barium pool within the intrathoracic stomach, with the proximal tip of the bezoar (white arrow) projecting above the pool. Gastroparesis was observed at fluoroscopy. This patient presented with intermittent nausea, abdominal bloating and dysphagia that improved without treatment. Follow-up endoscopy 21 days after the barium study showed resolution of the bezoar.

View larger version (168K): [in this window] [in a new window]   Figure 4. A 56-year-old woman with a bezoar in a gastric pouch after a vertical banded gastroplasty. A frontal spot image from a single-contrast upper gastrointestinal tract examination shows a vertical banded gastroplasty with a relatively homogeneous mass (white arrows) filling almost the entire pouch (large black arrows) above the banded segment (small black arrow), which was incompletely filled on this view. Also note barium in the remainder of the stomach. This patient presented with nausea and vomiting that improved on a diet restricted to clear liquids. Follow-up endoscopy 1 day later showed resolution of the bezoar.

View larger version (68K): [in this window] [in a new window]   Figure 5. A 60-year-old woman with a bezoar in a gastric pouch after a gastric bypass with Roux-en-Y reconstruction. (a) A frontal spot image from a single-contrast upper gastrointestinal tract examination shows the bezoar as an ovoid, homogeneous mass (white arrows) filling the gastric pouch. Also note barium in the jejunal loops (large black arrows) distal to the gastrojejunal anastomosis (not well visualised). There is also breakdown of the gastric staple line with barium entering the body and antrum of the stomach (small black arrows). (b) A right posterior oblique spot image shows the bezoar (large black arrows) in the gastric pouch, with barium entering the proximal jejunum via a patent gastrojejunal anastomosis (small black arrows). This view also delineates the site of breakdown of the staple line (large white arrow), with barium entering the gastric body and antrum (small white arrows). This patient's treatment and clinical course were unknown.