Abstract
A case of gastric bezoar in a 6-year-old child is discussed. The child presented with megaloblastic anemia due to vitamin B12 deficiency. In addition, hyperfolatemia and hypoalbuminemia were demonstrated. A combination of low B12 and markedly elevated serum folate in the presence of megaloblastic anemia suggests bacterial overgrowth within the upper small bowel. The implications of this combination of findings on the operative procedure for removal of the bezoar are discussed.
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Lanzkowsky P, Erlandson ME, Bezan MI: Isolated defect of folic acid absorption associated with mental retardation and cerebral calcification. Blood 34:452–465, 1969
Carmel R, Waxman S, Epstein B, Rausen A, Jeffries G, Herbert V: Acquired (?) selective malabsorption of B12 in a family. Astract W-3. Simultaneous Sessions, XII Congress International Society of Hematologists, New York, 1969
Arakawa T: Congenital defects in folate utilization. Am J Med 48:594–598, 1970
Mahoney MJ, Rosenberg LE Inherited defects of B12 metabolism. Am J Med 48:388–391, 1965
Donaldson RM Jr: Malabsorption in the blind loop syndrome. Gastroenterology 48:388–391, 1965
Scudmore H, Hagedorn AB, Wollaeger. EE, Owen CA Jr: Diverticulosis of the small intestine and macrocytic anemia with report of two cases and studies on the absorption of radioactive B12. Gastroenterology 34:66–82, 1958
Halsted JA, Lewis PM, Gasster M: Absorption of radioactive vitamin B12 in the syndrome of megaloblastic anemia associated with intestinal stricture or anastomosis. Am J Med 20:42–52, 1956
Goldstein F, Wirts CW, Kowlessar OD: Diabetic diarrhea and steatorrhea: microbiologic and clinical observations. Ann Intern Med 72:215–218, 1970
Kahn IJ, Jeffries GH, Sleisenger MH: Malabsorption in intestinal scleroderma. N Engl J Med 274:1339–1344, 1966
Herbert V: Aseptic addition method for lactobacillus casei assay of folate activity in human serum. J Clin Pathol 19:12–16, 1966.
Lau KS, Gottlieb C, Wasserman LR, Herbert V: Measurement of serum vitamin B12 level using radioisotope dilution and coated charcoal. Blood 26:202–214, 1965.
Hoffbrand AV, Tabaqchali S, Mollin DL: High serum folate levels in intestinal blind-loop syndrome. Lancet 1:1339–1342, 1966.
Hoffbrand AV, Tabaqchali S, Booth CC, Mollin DL: Small intestinal bacterial flora and folate status in gastrointestinal disease. Gut 12:27–33, 1971
Jaatoul N, Watson WC: Subacte combined degeneration of the cord and the production of folic acid by intestinal bacteria. J Canad Med Assoc 104:407–408, 1971.
DeBakey M, Ochsner A: Bezoars and concretions: a comprehensive review of the literature with an analysis of 303 collected cases and a presentation of 8 additional cases. Surgery 4:934–963, 1938
Szemes GC, Amberg JR: Gastric bezoars after partial gastrectomy. Radiology 90:765–768, 1968
Cain CD, Moore P Jr, Patterson M: Bezoars: a complication of the postgastrectomy state. Am J Dig Dis 13:801–809, 1968
Kurashev RI: Pitch bezoar of the stomach. Vestn Rentgenol Radiol 32:Suppl 1:25–28, 1957
Shadrina MV: Lipoid bezoar. Vestn Khir 83:131–132, 1959
Inlow HH: Shellac bezoars. Radiology 34:618–625, 1940
Paul M: An unusual accident. Med Press 196:510–511, 1938
Giannella RA, Broitman SA, Zamcheck N: Competition between bacteria and intrinsic factor for vitamin B12: implications for vitamin B12 malabsorption in intestinal bacterial overgrowth. Gastroenterology 62:255–260, 1972
Donaldson RM Jr, Corrigan H, Natsios, G: Malabsorption of cobalt 60 labeled cyanocobalamin in rats with intestinal diverticula. I. Evaluation of possible mechanisms. II. Studies on the contents of the diverticula. Gastroenterology 43:271–290, 1962
Cameron DG, Watson GM, Witts LJ: The experimental production of macrocytic anemia by operations on the intestinal tract. Blood 4:803–815, 1949.
Bernstein LH, Gutstein S, Efron G, Wager G: Experimental production of elevated serum folate in dogs with intestinal blind loops: relationship of serum levels to location of the blind loop. Gastroenterology (In press)
Bernstein LH, Gutstein S, Efron G, Wager G: Experimental production of elevated serum folate in dogs with intestinal blind loop. II. Nature of bacterially produced folate coenzymes in blind loop fluid. (Submitted for publication)
Davies IH: Hair-balls or hair cysts of the stomach and gastro-intestinal tract. Lancet 2:791–795, 1921
Wine PM: Trichobezoar presenting as nutritional oedema. Br Med J 2:510, 1957
Valberg LS, McCorriston JR, Partington MW: Bezoar: An unusual cause of protein-losing gastroenteropathy. J Canad Med Assoc 94:388–391, 1966
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This work was supported by US Army Contract (DADA-17-68-C08112).
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Bernstein, L.H., Gutstein, S., Efron, G. et al. Trichobezoar — An unusual cause of megaloblastic anemia and hypoproteinemia in childhood. Digest Dis Sci 18, 67–71 (1973). https://doi.org/10.1007/BF01072241
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DOI: https://doi.org/10.1007/BF01072241