[Bezoar with real and simulated complications]

Area of Science:

• Gastroenterology
• Surgical Case Reports

Background:

• Acute upper gastrointestinal hemorrhage necessitates prompt diagnosis and management.
• Gastric phytobezoars are rare foreign bodies that can cause significant gastrointestinal pathology.

Observation:

• A 64-year-old patient presented with acute upper GI bleeding and radiographic evidence of subdiaphragmatic free air.
• Clinical examination revealed an unremarkable abdomen, contrasting with imaging findings.
• Endoscopy was limited by a large coagulum, obscuring the underlying pathology.

Findings:

• Surgical exploration revealed a large phytobezoar (15 x 8 x 8 cm) and a benign pressure ulcer.
• The free air was within the stomach, demarcated by the bezoar, mimicking a perforation.
• The gastric wall defect was not a true perforation but an ulcerated area associated with the bezoar.

Implications:

• This case underscores the importance of considering bezoars in the differential diagnosis of gastric emergencies, especially when imaging findings are atypical.
• Phytobezoars can present with diverse symptoms and radiographic findings, challenging initial diagnostic assessments.
• Accurate diagnosis and timely surgical intervention are crucial for managing bezoar-induced gastrointestinal complications.