Green urine: an association with metoclopramide

Sir, Green urine is a distinctly unusual and intriguing finding inclinical medicine. A healthy 28-year-old man presented to theemergency department with abdominal pain, nausea and vomitingof 1 day's duration. He did not take any medications, supplementsor any unusually coloured food items. The patient was afebrilebut had evidence of volume depletion     

Gastric bezoar

Bezoar consist of the accumulation of different substances in the digestive tract. We present the clinical case of a girl with gastric trichobezoar discovered in a postoperatory follow-up to an appendicectomy. Ultra-sound images and oesophagus-gastric transit are fundamental points in the diagnosis. Endoscopy was useful in confirming the diagnosis and in ruling out associated ulcus, frequent in these patients. Surgical treatment is the choice in big bezoar but laser, prokinetics and enzymatic dissolutions have also been used. Theses patients should undergo psychological control.     

Gastric outlet obstruction due to duodenal bezoar: A case report

INTRODUCTIONGastric outlet obstruction (GOO) is a clinical syndrome characterized by abdominal pain and postprandial vomiting. Causes of GOO include both benign and malignant disease. Bezoars, concretions of undigested or partially digested material in the gastrointestinal tract, are a rare entity and GOO due to duodenal bezoar is an uncommon presentation.PRESENTATION OF CASEWe report the case of a 56-year-old woman who presented to the emergency department acutely with a 3-day history of epigastric pain, weakness and postprandial nonbilious vomiting. Initially, an upper gastrointestinal endoscopy (UGE) was performed to evaluate the cause of the GOO. A solid impacted bezoar was detected in the first portion of the duodenum with complete obstruction of the pyloric canal. In spite of multiple attempts for fragmentation using different devices, the extraction attempts failed. We administered acetylcysteine and cola per os. Abdominal computerized tomography was obtained and showed a solid mass in the duodenum. UGE was performed once more however, the mass was not suitable for fragmentation and removal. Thus, surgical treatment was decided. The bezoar was extracted via gastrotomy. The postoperative period was uneventful.DISCUSSIONEven if a duodenal bezoar is small, because of its location it may cause GOO with abruptly clinical features. The diagnostic approach is similar to the other causes of the GOO. However, therapeutic options differ for each patient.CONCLUSIONWe should remember all the therapeutic and diagnostic options for a patient with upper gastrointestinal bezoars who present at the hospital whether or not there is a predisposing risk factor.     

Gastric bezoar after Roux-en-Y gastric bypass for morbid obesity: A case report

IntroductionWe aimed to present a patient with gastric pouch bezoar after having a bariatric surgery.Presentation of caseSixty-three years old morbid obese female had a laparoscopic Roux-en-Y gastric bypass surgery 14 months ago. She has lost 88% of her excess body mass index; but started to suffer from nausea, abdominal distention and vomiting lately, especially for the last two months. The initial evaluation by endoscopy, computed tomography (CT) and an upper gastrointestinal contrast series overlooked the pathology in the gastric pouch and did not display any abnormality. However, a second endoscopy revealed a 5 cm in diameter phytobezoar in the gastric pouch which was later endoscopically removed. After the bezoar removal, her complaints relieved completely.DiscussionThe gastric bezoars may be confused with the other pathologies because of the dyspeptic complaints of these patients. The patients that had a bariatric surgery; are more prone to bezoar formation due to their potential eating disorders and because of the gastro-enterostomy made to a small gastric pouch after the Roux-en-Y gastric bypass surgery.ConclusionPossibility of a bezoar formation should be kept in mind in Roux-en-Y gastric bypass patients who has nausea and vomiting complaints. Removal of the bezoar provides a dramatic improvement in the complaints of these patients.     

Laparoscopic removal of gastric bezoar

Many approaches have been proposed for the treatment of bezoars, such as gastroscopic fragmentation, nasogastric lavage or suction, and enzymatic therapy. Because gastroscopic removal has not always been successful, especially in large gastric bezoars, surgical removal by gastrotomy through abdominal incision has been performed. With the advent of laparoscopic surgery, it became possible to remove such lesions without large abdominal incisions. In this case, we present a 62-year-old male who had gastric phytobezoar that was successfully treated with a laparoscopic technique.     

Emergency gastrotomy: treatment of choice for iron bezoar

The authors believe that gastrotomy and surgical removal of tablets is the treatment of choice in massive iron ingestion with development of an "iron bezoar" unresponsive to gastric lavage. Prompt surgical treatment in such cases may be lifesaving.     

Green urine after surgical treatment of pressure ulcer.

We describe a 58-year-old man who developed green urine after operation on a pressure ulcer. The discolouration disappeared gradually after two days. We think that the use of methylene blue dye during the revision of the wounds and the use of the sedative propofol could have caused it.     

尿液成分对草酸钙结石的影响

目的 探讨尿液成分对草酸钙尿结石形成的影响。方珐 应用红外光谱仪对50份尿结石标本进行成分检测；对16例一水草酸钙（COM）与10例二水草酸钙（COD）尿结石患者的24h尿液进行生化检测，并比较两组生化指标。结果 87．5％的c0M结石患者和90％的c0D结石患者24h尿量减少；COM结石患者尿钙（4．94±2．11）mmol／24h，COD结石患者尿钙（9．43±3．78）mmol／24h；差异有统计学意义（P〈0．01）；COM结石患者尿磷（20．50±8．76）mmol／24h，COD结石患者尿磷（28．38±10．21）mmol／24h，差异有统计学意义（P〈0．05）；87．5％的COM结石患者尿枸橼酸低于正常水平。结论 COD结石患者尿钙、尿磷高于COM结石患者，表明COD结石的形成与高钙尿和高磷尿有关；COM结石的形成可能与低尿枸橼酸有关。     

Laparoscopy-assisted management of jejunal bezoar obstruction

Treatment of intestinal bezoar causing obstruction is usually straightforward by an open approach, with either digital fragmentation or removal of the bezoar via an enterotomy. Herein, we report a case of small bowel bezoar obstruction treated successfully by laparoscopic technique. The bezoar was fragmented manually via a minilaparotomy and then pushed into the cecum with laparoscopic forceps. Laparoscopic management is an alternative to conventional surgery for intestinal bezoar that provides shorter hospital stay and less postoperative pain and may be recommended as the treatment of choice of such patients.     

Invasive fungal bezoar requiring partial cystectomy

A 67-year-old man developed dysuria and position-dependent obstructive voiding symptoms after undergoing holmium laser ablation of the prostate (HOLAP) for benign prostatic hypertrophy. A large fungal (candidal) ball adherent to the bladder wall was removed by loop excision, but the bezoar recurred in 2 weeks despite systemic fluconazole and intravesical amphotericin B. A second attempt at endoscopic removal with ultrasonic lithotripsy, endoscopic graspers, and fulguration was also unsuccessful. The patient underwent open partial cystectomy to remove his invasive fungal bezoar. Convalescence was unremarkable. Urinalysis, culture, and follow-up cystoscopy after partial cystectomy demonstrated successful definitive treatment of the fungal ball.