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Reconstructed gastric conduit obstruction caused by a bezoar after esophagectomy: a case report

Authors
  • Hatoyama, Keiichiro1
  • Taniyama, Yusuke1
  • Sakurai, Tadashi1
  • Hikage, Makoto1
  • Sato, Chiaki1
  • Okamoto, Hiroshi1
  • Takaya, Kai1
  • Onodera, Yu1
  • Kamei, Takashi1
  • 1 Tohoku University Graduate School of Medicine/Seiryo-machi, Department of Surgery, Aoba-ku, Sendai, Miyagi, 980-8574, Japan , Sendai (Japan)
Type
Published Article
Journal
BMC Surgery
Publisher
BioMed Central
Publication Date
Jun 07, 2019
Volume
19
Issue
1
Identifiers
DOI: 10.1186/s12893-019-0525-5
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundBezoars are rare but may cause gastrointestinal obstruction and ulcers. To the best of our knowledge, only two cases of bezoars in the reconstructed gastric conduit have been reported, but there has been no report on reconstructed gastric conduit obstruction due to bezoars.Case presentationA 60-year-old man presented to our clinic with abdominal pain and vomiting that occurred suddenly after dinner. Three years before presentation, he had undergone radical thoracoscopic esophagectomy followed by reconstruction of the gastric conduit through the posterior sternum, for esophageal cancer. Enhanced computed tomography scans showed distension of only the gastric conduit without ischemia and distension of the small intestine. According to our findings, we initially diagnosed the patient with postoperative intestinal obstruction caused by adhesions. After conservative treatment failed, the patient underwent an endoscopic study that showed a bezoar at the pylorus ring. We initially failed to remove the bezoar endoscopically because of its large size; hence, we attempted enzymatic dissolution. Three days after the first endoscopic study, the bezoar was disintegrated using a snare and extracted during a second endoscopy. The patient recovered uneventfully and presented with no complications during the 1-year follow-up interval.ConclusionIn cases wherein the discharge of materials in the reconstructed gastric conduit is delayed, bezoars should be considered in the differential diagnosis, and an endoscopic study should be performed to verify the cause of obstruction.

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