Most of the reported bezoars are concretions of poorly digested materials. They are usually initiated in the stomach; although some of them may migrate into the bowel or backwardly into esophagus [1, 2, 4].
Bezoars usually form after a chronic ingestion or consumption of indigestible materials/foods [1, 8]. The condition reported here can be named as acute formed bezoar for plaster has been ingested in a moment and formed bezoar in less than 7 hours.
Bezoars may present with abdominal pain, epigastric distress, nausea, vomiting, fullness or bloating[8]. When complicated, diminished peristaltic sounds, rebound, tenderness, distention, diarrhea, constipation, vomiting, and abdominal pain could be found clinically[9]. The main manifestation of our patient was abdominal pain, nausea and vomiting, introducing partial gastric outlet obstruction.
The diagnosis often can be made on the basis of findings of conventional radiography and barium studies [10]. On plain abdominal radiography, we found an opaque bezoar, which formed a perfect cast of the stomach (figure 2). Therefore, the contrast study was not needed.
Endoscopic investigations could show all of gastric bezoars [11]. Bezoars located in the esophagus or stomach should be treated conservatively in the first instance. Surgery is recommended in cases with massive and non-progressive foreign bodies, or complicated cases presenting with perforation, penetration, hemorrhage, or obstruction. Moreover, those causing acute intestinal obstruction require surgical intervention [4, 12]. In our patient we tried to fragment the bezoar by endoscope, but we were not successful. Furthermore, our attempt to insert nasogastric tube failed.
Gastric bezoar is commonly removed by longitudinal gastrotomy. If complicated, a few percent of cases can be treated by gastric resections [12]. Our case presented with a large non- movable mass, with manifestations of obstructions. Therefore, gastrotomy and removal of foreign body was performed.
The other part of management of such a bizarre bezoar is thinking whether the ingested material is toxic or corrosive. Plaster or Gypsum (Calcium Sulfate Dihydrate) is a non-toxic agent, which can release nuisance dust in handling or during use. In this manner it may affect eye, skin, nose, throat and upper respiratory tract. Prolonged and repeated exposure can result in lung disease (i.e., silicosis) and/or lung cancer. Incidental ingestion of a sufficient quantity could lead to a mechanical obstruction of the gut, especially the pyloric region[13]. Also, we did not detect any systemic and localized toxicity in our patient. Therefore, no specific care was needed for intoxication.
As most of the patients with bezoar were suffering from psychiatric disorders, psychiatric intervention and management is found to be imperative to prevent recurrence in such cases. More importantly, suicidal attempt of our patient made this part of management more necessary.
