Bezoar: an uncommon cause of intestinal obstruction.

Bezoars or undigested food concretions in the gastrointestinal tract are mostly due to ingestion of a stringent immature fruits following gastric surgery and can lead to the serious complication of acute small bowel obstructions. We are reporting a case of complete jejunal obstruction in a 60 year old female, 15 years following bilateral vagotomy and gastrojejunostomy for pyloric obstruction. Important clinical and pathological features are emphasised to increase the awareness of this rather uncommon cause of intestinal obstruction.     

Bezoar following gastrectomy

Summary An intragastric grape phytobezoar occurred 1 month after hemigastrectomy, duodenostomy, and vagotomy. Bezoar formation was believed due to a combination of reduced proteolytic enzyme activity, faulty mixing, gastric stasis, and impaired mastication. Medical therapy with oral proteolytic enzymes and gastric lavage resulted in the complete disappearance of the bezoar, as demonstrated both roentgenographically and gastroscopically.     

Nonoperative Management of Persimmon Bezoar

The soft phytobezoars occurring in the postoperative stomach may be readily removed by enzyme digestion and manipulation. In contrast, the persimmon bezoar (diospyrobezoar) has been persistently resistant to such treatment and has required surgical removal. Experience with unsuccessful attempts at enzyme digestion in a number of such patients led to the experimental use of a "soaking" technic which satisfactorily dissolved two of three large persimmon bezoars and shrank the remaining foreign body sufficiently so that it could be removed endoscopically by way of the esophagus. A concomitant gastric ulcer healed uneventfully on medical therapy.     

Polystyrene Bezoar in a Patient with Polystyrenomania

A 35-yr-old man with hematemesis, epigastric pain, and no predisposing factors to delayed gastric emptying was found to have a gastric bezoar. Surgical removal was required. Pathological and biochemical examination revealed a mass composed of polystyrene. This represents an unusual composition and a newly recognized predisposing factor to bezoar formation, "polystyrenomania" from ingestion of styrofoam cups.     

Late "adult form" scimitar syndrome presenting with "infant form" complications

This case report describes an 85-year-old woman with complications resulting from scimitar syndrome, anomalous drainage of the right pulmonary veins into the inferior vena cava. In addition to being the oldest reported case of this congenital anomaly, this is the first report of pulmonary vascular complications from scimitar manifested in the adult. The magnitude of the vascular shunt and advanced nature of the disease precluded surgical or percutaneous intervention in this patient.     

Gastric Bezoar Caused by Lecithin: An Unusual Complication of Health Faddism

We discovered an unusual bezoar in a previously healthy man who had been ingesting large amounts of a vegetable-derived oil touted to contain lecithin, which he purchased from health food stores in the belief that it had beneficial effects in lowering cholesterol levels and improving memory. The large intragastric mass, composed of fatty acids and lecithin, led to considerable morbidity, including abdominal pain, early satiety, and significant weight loss, and required surgical removal.     

"Sinus node" reentrant tachycardia associated with respiration

A 77-year-old woman (case 1) and a 57-year-old woman (case 2) with paroxysmal "sinus tachycardia" are reported in whom the tachycardia repeatedly occurred associated with respiration. In both cases, reentrant P' waves are almost the same in configuration as sinus P waves, and P'R intervals are also the same in length as PR intervals. In case 1, the tachycardia was initiated during inspiration, and was terminated during expiration; showing tachycardia-dependent initiation. On the contrary, in case 2, the tachycardia was initiated during expiration, and was terminated during inspiration; showing apparent bradycardia-dependent initiation. Although exact diagnosis was not made by electrophysiologic studies, attempts were made to explain the mechanism of such unique tachyarrhythmias associated with respiration by using the concept of sinus node reentrant tachycardia as a possible mechanism.     

Unusual endocarditis: "rare bug, rare site"

A 27-year-old man was diagnosed with infective endocarditis due to Streptococcus agalactiae. Large vegetations were seen on the anterior mitral valve leaflet and also on the right ventricular side of a membranous ventricular septal defect. Streptococcus agalactiae is a rare cause of endocarditis, and it is very rare to find large vegetations around ventricular septal defect. The authors present this interesting case of unusual endocarditis with vegetations in both the right and left heart. This case is the first reported case of infective endocarditis involving the left and the right sides of the heart at the same time in a nonintravenous drug user.     

Morphological observations following "anatomical correction" for abnormal ventriculo-arterial connection

Seven postmortem hearts from children who underwent anatomical correction for complete transposition (6 cases) and double outlet right ventricle (1 case) were examined in order to gain a better understanding of the pathological morphology in relation to the surgical procedure. Associated malformations were ventricular septal defect in all, patient arterial duct in 4 and aortic coarctation in 3. In all hearts the coronary arteries arose from the facing aortic sinuses and were relocated into the facing sinuses of the pulmonary trunk with minimal displacement. The orifices of the coronary arteries were reduced in caliber in one case. The sinus node artery arising from a lateral atrial artery was transected in one case. The Lecompte maneuver was performed in 4 cases and tension on the pulmonary trunk was observed in 2 cases. Potential right ventricular outflow tract obstruction was evident in all (including one in which it had been resected during surgery). The substrates of obstruction were anomalous parietal insertion of the outlet septum (2 cases), anomalous muscular trabeculation (1 case), rightward displacement of the outlet septum (1 case), parietal insertion of the outlet septum (1 case) and restrictive muscular infundibulum (1 case--DORV). In addition, all the complete transposition cases had hypertrophy of the parietal right ventricular wall. This study highlighted the anatomical features which could lead to poor results in the anatomical correction procedure. Some of the potential problems could be avoided by minor modifications to the technique.     

Legionellosis and "torsades de pointes"

Myocarditis, pericarditis and endocarditis are rare manifestations of Legionella pneumophila infection. We describe a case of myocarditis complicated with a potentially fatal arrhythmia: "torsades de pointes".