Bezoars: a rare cause of Rapunzel syndrome and large bowel obstruction by sigmoid volvolus

Abstract

Background: Bezoars are conglomerates of indigested materials that accumulate in the gastrointestinal tract. The aim of this work was to study our cases of bezoars and its different management modalities.

Methods: This is a retrospective study of the patients diagnosed to have gastrointestinal bezoars that were admitted to our institute from the start of 2008 to the end of 2014. The clinical data, management, and outcomes of these patients were studied.

Results: Bezoars were present in 8 patients. There were 5 female patients (62.5%) and 3 males, and the median age was 28 years (range: 16-54). Gastric bezoars were present in 5 patients, all were females and all were trichobezoars. One of them was extending to the duodenum with a tail of hair, making what is called rapunzel syndrome. Two were treated by endoscopy, two needed open laparotomy with gastrotomy and one treated conservatively. Small bowel bezoars were phytobezoars that caused small bowel obstruction in two male patients. One treated conservatively, and laparotomy and enterotomy done in another patient. One male patient with sigmoid bezoars caused volvolus and ischemia of the sigmoid colon. This was treated with laparotomy, sigmoid resection and colostomy. There were no mortality and very low morbidity.

Conclusions: Bezoars are uncommon causes of gastrointestinal diseases. Presentations depend on the site and size of the bezoars. Gastric bezoars are usually trichobezoars and are more common in young females. Rapunzel syndrome is a rare presentation of trichobezoars. Small bowel bezoars are usually phytobezoars, and their usual presentation is small bowel obstruction. Sigmoid volvolus is a very rare presentation of colonic bezoars. Different treatment modalities are needed according to its type and location.