A Case of a Giant Gastric Bezoar Successfully Removed by Laparoscopic Gastrotomy

Abstract

An 81-year-old man presented to gastroenterology department of our hospital complaining of a sensation of food getting stuck in the esophagus and nausea. Computed tomography and esophagogastroduodenoscopy revealed multiple gastric bezoars and two small intestinal bezoars causing obstruction. Decompression using a long intestinal tube and dissolution therapy were initiated. Following this treatment, the small intestinal bezoars disappeared; however, the two gastric bezoars, one large and one small, remained unchanged. Endoscopic removal was attempted, and while the smaller bezoar was successfully extracted, the larger bezoar was deemed too massive for endoscopic extraction. The patient was then referred to our department for surgical intervention. We performed laparoscopic gastrotomy to remove the bezoar and closed the gastric wall by intracorporeal layer-by-layer suturing. The extracted bezoar measured 14.5 × 4 × 4 cm in size, and analysis of its composition revealed the presence of tannin. Postoperatively, the patient experienced delayed gastric emptying but was able to resume oral intake on postoperative day 10 and was discharged on day 22. Reports of laparoscopic removal of gastric bezoars remain scarce. By employing standard suturing techniques and minimizing the length of the gastric incision to match the bezoar’s short axis, intracorporeal suturing can be performed safely without prolonging the operative time.