Myra Lalas Pitt
1. NO DIRECT CT EVIDENCE OF
APPENDICITIS.
2. GASTRIC BEZOAR VERSUS
FOODSTUFF WITHIN THE STOMACH.
3. RIGHTSIDED ADNEXAL CYST WITH FREE
FLUID IN CUL DE SAC CONSISTENT
WITH CYST RUPTURE.
4. TRACE AMOUNT OF PERIPORTAL
EDEMA. ULTRASOUND MAY BE
OBTAINED
IF CLINICALLY INDICATED.
5. FECAL MATERIAL THROUGHOUT THE
ENTIRE COLON CONSISTENT WITH
CONSTIPATION.
Definition
Result from the accumulation of foreign
ingested material in the form of masses
or concretions
 Rare and occurs in <1% of the
population
 Grow by the continuing intake of food
rich in cellulose and other indigestible
materials such as hair, cotton, and
tissue paper, matted together by protein,
mucus, and pectin.

Pathophysiology
Properties of the ingested material and
some degree of gastric dysfunction may
lead to its formation
 Risk Factors:
Previous gastric surgery
Delayed gastric emptying

Signs and Symptoms
Phytobezoars: men in their 40s-50s
 Trichobezoars: women in their 20s
 Symptoms usually develop insidiously:
Abominal pain
Nausea/ vomiting
Early satiety
Anorexia
Weight loss
GI bleeding

Diagnosis

AXR:
CT Scan
Gastric trichobezoar
Treatment
Depend on their composition, location
and size.
 Dissolution therapy (cellulase,
acetylcystein, papain and Coca Cola)
 Endoscopic fragmentation and/or
aspiration
 Surgery


Endoscopic removal
of the yellowgreenish-colored
bezoar and normal
gastric mucosa.
Gastric bezoar dissolution with oral CocaCola® intake





Sara Regaño, Marisol Trugeda, Gonzalo Gutierrez, Susana
Menéndez and Gonzalo De las Heras, 05 May 2009
Lavage with Coca-Cola® as a safe and effective treatment for
gastric bezoars was first described in 2002
Case of 64 yo F with hypogastric pain & gastric fullness for 3
years; h/o DM type 2 and hyperthyroidism
Meds: Omeprazol®, plus oral antidiabetic agents, and
Thirodril
The patient was asked to drink 3 cans of Coca-Cola® per day
with every meal (33 cl. 3 times a day) for a month.



The mechanism of Coca-Cola® dissolution is not
fully explained.
Phosphoric acid (H3PO4) is responsible for Coke’s
pH of 2.6, which is close to the pH of gastric
secretions→ acidification of the gastric content
may be the way Coca-Cola® acts by disintegrating
the bezoar.
The release of carbon dioxide (CO2) bubbles into
the gastric lumen and the mucolitic action of
sodium bicarbonate (NaHCO3) may also contribute
to bezoar dissolution.
References
Azevedo et al. Successful endoscopic resolution of a large gastric
bezoar in a child. World J Gastrointest Endosc. 2011 June 16; 3(6):
129–132.
Regano et al. Gastric bezoar dissolution with oral Coca-Cola®
intake. May 2009 (www.gastrohep.com)
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