A Case of Large Gastric Perforation due to Bezoar

Abstract

Hina Gupta*, Ranjeet Ahirwar, Avinash Gautam, Suyog Andhare and Ram Mohan Shukla

Background: A bezoar is a tightly packed collection of partially digested or undigested material found trapped in the gastro-intestinal system, Though, it can occur in other locations in the body as well, the most common location is the stomach. When unrecognized, these habits of eating bezoars can lead to severe complications such as gastric ulceration and even perforation.

Methods: We report a case of 55 year old Indian male who presented to the emergency room with signs and symptoms of acute abdomen. Radiological study revealed bilateral pneumoperitoneum. Personal history revealed depressive symptoms.

Results: An emergency exploratory laparotomy was performed and gastric perforation with 800 gms of gravel stones in the enlarged stomach were present as a content. Anterior gastrojejunostomy with Feeding jejunostomy was performed after removal of stones. Patient was discharged on post-operative day 10 and followed up for post op complications and referred to psychiatry for further therapy.

Conclusion: Acute abdomen with hollow viscus perforation is an emergency where saving the time is crucial to avoid further peritonitis, shock or mortality. Gastrointestinal perforation and peritonitis in association with lithobezoars are rare entities where emergency interventions are must needed. Therefore, in patients with psychiatric behaviour and unusal dietary habits, bezoars as a differential diagnosis needs to be ruled out and managed with further psychiatric therapy.