Pediatric Bezoar

Etiology: Accumulation of undigested material in the gastrointestinal tract
— Trichobezoar = Hair – most common
— Phytobezoar = Indigestible plant or vegetable material
— Lactobezoar = Milk curd
Imaging: Large fixed filling defect in gastrointestinal tract which usually is in stomach
DDX:
Complications:
— Gastric outlet obstruction
— Gastrointestinal bleeding
— Protein-losing enteropathy
— Acute pancreatitis
— Small bowel obstruction
— Perforation
Treatment: Lavage or endoscopic removal or surgical removal
Clinical: Can also be rarely seen in the small bowel and colon

Radiology Cases of Bezoar

Radiology Cases of Trichobezoar

CT of trichobezoar — Coronal (above) and axial (below) CT with contrast of the abdomen show the stomach distended by a large mass that has a swirled appearance and that fills the entire stomach and the duodenal bulb.

AXR and Upper GI of trichobezoar — AXR AP (left) shows radio-opaque material filling and distending the midline stomach which is displacing the transverse colon inferiorly. AP image from an upper GI exam (right) shows a thin coat of barium outlining a large cast of material within the distended stomach. Endoscopy showed the stomach to be full of hair.

Radiology Cases of Phytobezoar

AXR and CT of phytobezoar — AXR (left) shows a mottled structure filling the entire width of the upper abdomen. Coronal CT with contrast of the abdomen (middle and right) shows the structure is the stomach distended with particulate material. The patient was given cellulase and an AXR one day later showed the stomach to be empty.