ACUTE APPENDICITIS, OBSTRUCTION AND GASTROINTESTINAL PERFORATION AS COMPLICATIONS OF BEZOAR. A CLINICAL CASE REPORT

Abstract

Objective: To report a clinical case of a patient who presented acute appendicitis, obstruction and gastrointestinal perforation as a complication of gastric bezoar. Surgical Service 1. Hospital Dr. Miguel Pérez Carreño. IVSS, Caracas. Patient and method: Presentation of a clinical case and literature review. Results: Male patient, 35 years old, with 48 hour history of actual illness, characterized by nausea, abdominal pain and bloating. On physical examination he was tachycardiac (119 beats per minute), tachypnea (24 per minute) and normotensive (110/80 mmHg). Painful abdomen to superficial and deep palpation, with signs of peritoneal irritation. Two radiopaque images
are shown in the plain abdominal radiography. An exploratory laparotomy is performed with findings of 1500 cc of purulent secretion and intestinal cavity free, a gastrointestinal bezoar, three perforations from 5 mm to 20, 30 and 40 cm of fixed loop. Phlegmonous cecal appendix, palpable with various objects in within. Bezoar by enterotomy is drawn to 30cm of ileocecal valve and gastrostomy in the anterior gastric body. Perforations are repaired with Lembert stitches. Enterorraphy, gastrorrhapy and appendectomy are performed. Conclusion: The bezoar is a rare cause of acute appendicitis, obstruction and gastrointestinal perforation. The main etiology of gastric bezoars reported in the literature, are due to mental disorders and gastric surgery which produce gastroparesis, hypochlorhydria and reducing the antral motility. The etiology of bezoar in this clinical case report was attributed to psychiatric disease of the patient. The histopathology result of the cecal appendix of the patient, reported acute appendicitis and physical artifacts in the surgical specimen. We attribute the acute appendicitis to the appendiceal lumen obstruction by foreign materials (objects). The removed bezoar is found in the group of bezoars to foreing materials.