Advertisement

Indian Journal of Surgery

, Volume 75, Supplement 1, pp 356–358 | Cite as

Bizarre Metal Bezoar: A Case Report

  • Gupta Suresh Kumar
  • Verma Amar
  • Bharti Ramesh
  • R. K. Abbey
Case Report

Abstract

Introduction

Bezoars are uncommon findings in the gastrointestinal tract and are composed of a wide variety of materials. Large metal bezoars are very rare with only a few case reports till date in literature. We report a case of a metal bezoar in a man with Maniac Depressive Psychosis who had a history of ingesting Nails and screws of sizes varying from 2 cm to 15 cm for more than 1 year without causing any perforation and other acute complication.

Case presentation

A 24-year-old man presented with a history of mild dull aching type of abdominal pain of chronic onset and no other GI symptoms. The patient had history of passing small sized nails in the stools and intermittent melena for last 1 year. Physical examination revealed mild tenderness in Para umbilical region. Past medical history was remarkable for treatment of Maniac depressive psychosis. Plain radio graphs revealed objects of metal density contained within a dilated stomach at the level of L2–3 vertebrae in the midline. Celiotomy was performed and 27 metal nails and screws of sizes 6 cm to 15 cm and bent in various shapes were removed from inside the stomach. Post operatively patient recovery was normal and he was referred to psychiatrist.

Conclusion

Abdominal pain in patients with psychiatric disorders can result from rare causes such as bezoars and such bizarre metal nails without causing any acute abdominal symptoms. This report alerts surgeons to rule out bezoars in the differential diagnosis of chronic abdominal pain and melenic stools with no abdominal symptoms in patients with psychiatric health problems.

Keywords

Bizarre Metal Bezoars Nails and screws 

Notes

Competing Interests

The authors declare that they have no competing interests.

References

  1. 1.
    Davis RN, Rettmann JA, Christensen B (2006) Relapsing altered mental status secondary to a meprobamate bezoar. J Trauma 61:990–991PubMedCrossRefGoogle Scholar
  2. 2.
    Steinberg JM, Eitan A (2003) Prickly pear fruit bezoar presenting as rectal perforation in an elderly patient. Int J Colorectal Dis 18:365–367PubMedGoogle Scholar
  3. 3.
    Robles R, Parrilla P, Escamilla C, Lujan JA, Torralba JA, Liron R, Moreno A (1994) Gastrointestinal bezoars. Br J Surg 81:1000–1001PubMedCrossRefGoogle Scholar
  4. 4.
    Salb RL (1956) Metallic bezoar. Med Radiogr Photogr 32:32–33PubMedGoogle Scholar
  5. 5.
    Kaplan R, Celebi F, Guzey D, Celik AS, Erozgen F, Firat N (2005) Medical image. Metal bezoar. N Z Med J 118(1219):U1588PubMedGoogle Scholar
  6. 6.
    Hall JD, Shami VM (2006) Rapunzel’s syndrome: gastric bezoars and endoscopic management. Gastrointest Endosc Clin N Am 16:111–119PubMedCrossRefGoogle Scholar
  7. 7.
    Ho TW, Koh DC (2007) Small-bowel obstruction secondary to bezoar impaction: a diagnostic dilemma. World J Surg 31:1073–1079CrossRefGoogle Scholar
  8. 8.
    Sharma RD, Kotwal S, Chintamani BD (2002) Trichobezoar obstructing the terminal ileum. Trop Doct 32:99–100PubMedGoogle Scholar
  9. 9.
    Kuroki Y, Otagiri S, Sakamoto T, Tsukada K, Tanaka M (2000) Case report of trichobezoar causing gastric perforation. Dig Endosc 12:181–185CrossRefGoogle Scholar
  10. 10.
    La Fountain J (1999) Could your patient’s bowel obstruction be a bezoar. Today Surg Nurse 21:34–37Google Scholar
  11. 11.
    Campos RR, Paricio PP, Albasini JLA (1990) Gastrointestinal bezoars. Presentation of 60 cases. Dig Surg 7:39–44CrossRefGoogle Scholar
  12. 12.
    Chintamani DR, Singh JP, Singhal V (2003) Cotton bezoar—a rare cause of intestinal obstruction: case report. BMC Surg 4:3–5Google Scholar
  13. 13.
    Goldstein SS, Lewis JH, Rothstein R (1984) Intestinal obstruction due to bezoars. Am J Gastroenterol 79:313–318PubMedGoogle Scholar
  14. 14.
    Andrus CH, Ponsky JL (1988) Bezoars: classification, pathophysiology, and treatment. Am J Gastroenterol 83:476–478PubMedGoogle Scholar
  15. 15.
    Gupta R, Share M, Pineau BC (2001) Dissolution of an esophageal bezoar with pancreatic enzyme extract. Gastrointest Endosc 54:96–99PubMedCrossRefGoogle Scholar

Copyright information

© Association of Surgeons of India 2012

Authors and Affiliations

  • Gupta Suresh Kumar
    • 1
  • Verma Amar
    • 1
  • Bharti Ramesh
    • 1
  • R. K. Abbey
    • 1
  1. 1.Department of SurgeryDr Rajinder Prasad Medical CollegeKangra at TandaIndia

Personalised recommendations