Bezoar of a stomach
Bezoar of a stomach – the foreign matter which is formed in a stomach at a proglatyvaniye of some substances of a natural or synthetic origin. It is shown by pain in an epigastriya, a loss of appetite, nausea, vomiting, quickly arising feeling of saturation at reception of a small amount of food. Diagnostics is based on data of the anamnesis, a X-ray analysis of a stomach and gastroscopy. At concrements of a soft consistence warm alkaline drink, use of enzymatic medicines is shown to patients. At foreign matters of average density use endoscopic destruction and extraction of bezoar. In case of inefficiency of conservative therapy carry out surgical removal of a stone.
Bezoar of a stomach
Bezoar of a stomach (a gastric stone) – the concrement of various density which is formed at a proglatyvaniye of substances which are not digested in a stomach. The name of a gastric stone is connected with breed of mountain bezoarovy goats in whose stomachs often found grayish-blue concrements from wool, slime and leaves. In domestic gastroenterology the first mentions of pathology meet at the beginning of the 19th century in works of the Russian surgeon V. M. Mysh. Gastric stones arise seldom, for the beginning of the 1990th about 400 cases of a disease were described. Concrements can be single, reaching weight to 1 kg, and multiple. The last have the small sizes, are inclined to migration in a duodenal and lean gut.
Reasons of a bezoar of a stomach
The disease arises at a repeated proglatyvaniye of objects of an organic or inorganic origin, is more often with food. Allocate states and conditions which increase probability of formation of bezoar:
- Mental disorders. Neurosises, a trikhotillomaniye, schizophrenia, intellectual backwardness can become the reason of uncontrolled absorption of inedible substances (plasticine, glue, hair) in a large number.
- Stomach diseases. Insufficient release of hydrochloric acid, slow evacuation of contents in a 12-perstny gut owing to gastroenterologichesky pathology (, sekretorny insufficiency) causes gradual formation of concrements. Excess reproduction of mushrooms of a sort Candida in a stomach initiates formation of fungal bezoar.
- Stomach operations. The postponed surgical interventions (a stomach resection, a vagotomiya) promote decrease in sekretorny function, digestion violation, accumulation of products hard to digest.
- Violation of culture of food. The bad chewing of coarse-fibered heavy food, a proglatyvaniye of stones of fruit can provoke formation of a bezoar of a stomach.
The mechanism of formation of bezoar is various, depends on type of alien substance and existence of the contributing factors. A foreign matter, getting to an organism with food or as a result of addictions, for various reasons is not digested, and accumulates in a body or a pilorichesky part of a stomach. At the repeated use the substratum increases in a size. Influence of enzymes of gastric juice causes consolidation and hardening of a foreign matter. It is as a result formed which grows, can fill all volume of body. The there is longer a formation of a stone and stay it in a stomach, the it is firmer.
Bezoara of a stomach can have various structure and a consistence (friable, dense, firm, elastic). Depending on an origin allocate the following main types of gastric concrements:
- Fitobezoara. Make up to 70% of all bezoar. Are formed at consumption of a thin skin, stones, a peel of berries and fruit (a persimmon, sweet cherry, grapes, a fig, etc.). Vegetable substances gradually acquire slime, fat and are mineralized. Concrements have various consistence, a fetid smell, dark green or brown color.
- Trikhobezoara. Are formed at regular hit of hair in a stomach. Arise at nevrozopodobny states and mental deviations with insuperable thirst for a nibble of hair more often.
- Stibobezoara. Are formed at the frequent use of fat animal products (fat, mutton). Getting into a stomach, food is transformed, condensed with formation of fatty concrements.
- Shellakobezoara. Arise when using in food of inedible products of a chemical origin (a varnish, paint). At receipt in a stomach of substance interact with water, drop out in a deposit. Shellac stones have a viscous consistence, slightly rough surface, dark brown color.
- Stones of an embryonic origin. Also endoderma at a stage of pre-natal development are formed from ekzo-. Represent dermoidny cysts or teratoma of a stomach.
- Laktobezoara. Are formed at newborn children whose feeding is carried out by artificial mix with the high content of lactose and casein. Premature children are inclined to formation of concrements.
There are rare species of gastric stones which in medical practice meet in isolated cases. Piksobezoara are formed at the use of pitch or a var. Gemobezoara are formed at long swallowing blood at patients with nasal and esophageal bleeding. Concrements can arise at reception of almost insoluble and insoluble medicines (, aluminum hydroxide, absorbent carbon). Miksobezoara consist of threads, wool, wood pieces.
Symptoms of a bezoar of a stomach
Speed of formation of gastric concrements is various, varies from several days to one decades. It depends on composition of alien substance and specific features of an organism of the patient. At the small size of a concrement symptoms of a disease are absent. In process of increase in a bezoar there are painful feelings in the area an epigastriya, the feeling of weight in a stomach which is not connected with meal. Patients note bystry saturation by a small amount of food, nausea, vomiting, feeling of a raspiraniye in a stomach, a loss of appetite and body weights. There is a frequent eructation having an unpleasant smell.
Further pains accrue, accepting sharp or skhvatkoobrazny character. In a stomach there is a feeling of a foreign matter which can change location. At persons of an asthenic constitution dense education in epigastralny area is sometimes palpated. Existence of a bezoar is followed by decrease in immunity, an exacerbation of chronic diseases. Children because of violation of metabolic processes and hypovitaminosis have a gipoproteinemiya, hypostases of soft fabrics and the lower extremities.
Long finding of a bezoar leads to formation of decubituses of a wall of a stomach. Local blood circulation is broken, ischemia and a necrosis with formation of ulcerations develops. Erosion, stomach ulcers can lead to perforation of a muscular layer and developing of peritonitis and sepsis. A rare complication is intestinal impassability. At hit of a bezoarny stone obturatsionny intestinal impassability develops in a small intestine and overlapping of a gleam of intestines.
Diagnostics of a bezoar of a stomach causes considerable difficulties. It is connected with lack of specific symptoms and clinical manifestations at the initial stage of a disease. For confirmation of the diagnosis it is necessary to conduct the following examinations:
- Survey of the gastroenterologist. The expert on the basis of the anamnesis of life, a course of disease, data of fizikalny survey will draw pre-trial detention and will appoint additional diagnostic procedures.
- Stomach X-ray analysis with contrasting. Allows to define defect of filling of oval or rounded shape with accurate edges.
- Fibrogastroduodenoskopiya. The main method of diagnostics by which it is possible to define not only the size and a form, but also to assume an origin of a bezoar. During the procedure the endoscopist carries out a material intake for studying of structure of a concrement.
For diagnosis of a disease carry in addition out ultrasonography of an abdominal cavity. The computer tomography of the top departments of a GIT allows to define exact localization, the sizes of a bezoar. Development of anemia can cause laboratory analyses of a maloinformativna, a long course of disease. The main differential diagnostics of bezoar is carried out with malignant and benign tumors of a stomach. In this case the endoscopic research with a biopsy helps to distinguish concrements from new growths. Gastric stones differentiate with the swallowed foreign matters. Are of great importance given the anamnesis and gastroscopy.
Treatment of a bezoar of a stomach
Treatment of a disease depends on a look, a consistence, structure of a concrement and the accompanying pathology. At the small sizes the gastric stone can leave independently. Conservative methods of treatment are effective at bezoara of a soft and average consistence, is more often than a phytogenesis. Orally appoint warm alkaline solutions on the basis of soda, mineral water, proteolytic enzymes. Light massage of epigastralny area has positive effect. The sparing diet with restriction of fruit, meat and fat products is shown to patients. Concrements of small density delete endoscopic. By means of special tools the stone is split up and taken under control of the gastroscope. At persuasive conditions, the use of inedible products consultation of the psychiatrist is shown.
At inefficiency of therapy, big and dense bezoara carry out expeditious removal of a concrement. Operation consists in a section of a stomach (gastrotomiya) and removal of a bezoarny stone. The indication to surgical intervention are the states caused by a disease complication (intestinal impassability, peritonitis).
Forecast and prevention
At timely diagnostics and removal of a bezoar of a stomach forecast favorable. Conservative and surgical treatment yields good results, in 90% of cases there comes the absolute recovery. Ignoring of symptoms of a disease and late diagnostics can lead to a row serious, sometimes fatal, complications. For prevention of development of a bezoar persons with chronic gastrointestinal diseases or undergone stomach operations are recommended to undergo once a year dispensary inspection at the gastroenterologist. Control of mentally sick people, limited consumption of rough food of a vegetable and animal origin, refusal of the use of indigestible substances belongs to prevention of a disease.