GIT Bezoars And Foreign Objects
A bezoar is a tight mass of undigested organic materials such as hair, or partially digested vegetable matter, retained in the stomach or elsewhere in the gastrointestinal tract (GIT). Foreign bodies include swallowed objects remaining in the digestive tract; they occasionally result in perforation of the intestines.
- Bezoars as well as foreign bodies may remain in the digestive tract without causing any symptoms.
- These undigested masses may get stuck in different parts of the gastrointestinal tract.
- An x-ray of the gastrointestinal tract may detect the presence of bezoars or foreign bodies. The gastrointestinal tract may be examined with a flexible viewing instrument called endoscope to confirm the diagnosis.
- Bezoars as well as foreign bodies are often eliminated via bowel movements but if any remaining large object causes discomfort, it may have to be broken down to smaller pieces for easy elimination, or surgically removed.
The bezoars and foreign objects are more often found in the stomach. Some of the undigested organic matter or partially digested food may form lumps which remain inside the stomach if they are too large to pass through the pyloric sphincter which regulates the passage of food from the stomach into the duodenum. Any object, whether it is a foreign body or a bezoar, having a diameter of three fourth of an inch or more may not be able to pass out into the intestine through the pyloric sphincter. The structure of the stomach with its curved shape is another reason for objects getting stuck there.
Indigestible material like hair or certain types of fiber contained in the fruits and vegetable, mixed with partially digested food particles and certain residue from drugs such as antacids clump together and become hardened lumps to form bezoars. They usually form in the stomach, but they can occur in other parts of the gastrointestinal tract too. They get stuck in parts of the digestive tract when they cannot pass through the smaller openings and valves at the junction of the different digestive organs.
Swallowing of small objects by children is very common. Adults too may swallow things intentionally or unintentionally, especially under the influence of intoxicants like alcohol. Smugglers swallow drug-containing balloons to pass through customs check at the airports.
Small objects usually pass down the digestive tract and out with the stool without causing any discomfort. Larger objects may get stuck in the esophagus or sometimes in the stomach, unable to move forward. Sharp objects like fish bones may pierce the wall of the digestive tract and remain stuck there.
Undigested food particles and other substances can accumulate in anyone’s digestive tract but certain conditions make some people more prone to it. Surgeries of the digestive tract, especially the surgical removal of a portion of the stomach or a part of the intestine, make people more prone to developing bezoars. People who have diabetes may have the problem of incomplete emptying of the stomach, which can lead to accumulation of food particles and lump formation.
Symptoms and Diagnosis
Foreign bodies and bezoars do not cause any symptoms in most cases. When the object swallowed is small and blunt, the person may feel that something has got stuck somewhere in the esophagus. Even when the object has moved on to the stomach, the feeling in the esophagus may remain. If the object swallowed is sharp, it may get stuck in the wall of the esophagus causing pain. If the object is small, it may not obstruct the passage of food. But if the object is large enough to completely block the esophagus, the person may not be able to swallow even the saliva and may start drooling and continuously spitting. Even if the person repeatedly tries to vomit, it may not be successful. If the esophagus gets pierced by a sharp object, serious consequences may result.
Occasionally, bleeding may occur due to foreign objects or bezoars and the stools may be stained with blood. When they cause partial or total obstruction in the stomach or in the small intestine, it may result in severe pain and cramping, loss of appetite, bloating and vomiting sometimes accompanied by fever. Obstruction in the large intestine is rare but perforations can occur there as well as in the small intestine and the stomach. Perforations are serious situations requiring immediate medical intervention as the content of the stomach and the intestines may spill into the abdominal cavity and cause a life threatening condition called peritonitis. Severe pain in the abdomen and fever are the usual symptoms which follows a leakage of the stool into the abdominal cavity. The person may faint, or go into shock, and it can even lead to a fatal outcome, if not treated promptly. When a drug-containing balloon is swallowed, there is the risk of the balloon bursting and releasing all its contents all at once leading to a dangerous overdosing of that drug.
When obstructions due to bezoars or other foreign bodies are seen on the x-ray, further investigations are done to rule out tumors. Endoscopic examination of the gastrointestinal tract is conducted using a flexible viewing tube to see the object directly. An ultrasound scan or a CT scan also may be useful in identifying the object but not necessary.
Treatment
As long as ingested foreign bodies or bezoars do not cause considerable discomfort, they are left alone. A small object like a coin usually passes out without any treatment. People may be advised to check the stools in the following days to ensure that the object has come out. A liquid diet is sometimes prescribed to aid in the elimination of the foreign body.
Larger bezoars may have to be broken down to facilitate their excretion or for easy removal. Instruments like forceps are used break the lump into smaller bits. Laser technology is also used for this purpose. Meat tenderizer or an enzyme called cellulase in a solution, when taken orally for many days, may help break down bezoars for easy elimination.
When a blunt object is detected in the esophagus, an attempt is made to help it pass down the digestive tract without surgical intervention. Intravenous administration of glucagon helps the esophagus to relax, which may help the onward movement of the object. Metoclopramide is a drug taken orally to make the muscles of the gastrointestinal tract to contract, propelling the foreign bodies and bezoars forward and out of the body. Sometimes, objects which are lodged in the esophagus can be removed by doctors with a forceps or with an endoscope which has a basket inserted through it.
To avoid the risk of sharp objects piercing the esophageal wall, they are always removed either surgically or by using an endoscope. Since batteries are corrosive in nature, they have to be removed to avoid causing chemical burns inside the esophagus. If drug-containing balloons are swallowed, they have to be removed as soon as possible to avoid drug overdose that can occur if they burst.
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Yasser Elnahas
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