Delayed gastric emptying associated with gastric bezoar.

A 56-YEAR-OLD man presented with a 6 month history of constant bloating epigastric pain unaccompanied by any sensation of nausea or vomiting. The pain was experienced when he assumed an upright posture and was relieved by lying supine or deep breaths. The patient also gave a history of poor apetite and lost 16 pounds of body weight over a year. His medications included cimetidine 300 mg twice a day and Mylanta PRN for abdominal pains. His other illnesses included hypertension, abdominal aortic aneursym, and mild chronic interstitial lung disease. On examination the vital signs were normal. Abdomen was negative for any masses or tenderness. Abdominal computerized axial tomography (CT) was normal. Upper gastrointestinal (GI) series were unremarkable except for a small hiatal hernia without reflux. A gastric emptying using 2 mCi of TC-99m sulfer colloid labelled to an egg meal revealed emptying half time (T 1/2) of 308 minutes. (Normal T 1/2 is 67 + 17 min (Mean _+ 1 SD, N = 8). The stability of radiolabelled egg meal in our laboratory is 94.8 _+ 2.4% at two hour post incubation in simulated gastric juice. An upper GI endoscopy revealed a vegetable bezoar. The patient underwent orogastric lavage removal of bezoar followed by intermittent nasogastric suction with relief of abdominal pain. A repeat gastric emptying study revealed gastric emptying half-time of 125 mintues and correlated with clinical improvement. Figure 1 in top row reveals the gastric emptying study when T I/2 was 308 minutes. At ten and 30 minutes after ingestion of test meal (Figs 1A and 1B) the activity is confined to fundus and on the 60 and 90 minute images some activity passes into pylorus and a filling defect in the body of the stomach is evident (Figs 1C and 1D). The filling defect probably represented bezoar. Figure 1 in bottom row exhibits followup gastric emptying study performed a week after removal of vegatabIe bezoar. The radiolabelled meal promptly fills the entire stomach and the filling defect has been markedly reduced in size. The gastric emptying half-time improved to 125 minutes. Delayed gastric emptying due to gastric bezoar is a rare condition and can be effectively treated. Depending upon the presence or absence of mechanical/anatomical obstruction the pathological conditions associated with delayed gastric emptying can be divided into obstructive and non-obstructive categories. The non-obstructive causes may also be termed gastroparesis or functional obstruction. Pathological Conditions Associated With Delayed Gastric Emptying: