Master Ma had just retired when he developed symptoms such as upper abdominal pain, loss of appetite, and weight loss. After taking medication to aid digestion for two months with no effect, he was diagnosed with gastric antral cancer and underwent a radical gastrectomy. His postoperative recovery was good. Two years later, the aforementioned symptoms reappeared, a mass could be felt in the upper abdomen, and he also developed bloody stools. An upper gastrointestinal barium meal examination showed a large amount of retained fluid in the remnant stomach, a 4-cm filling defect at the gastrojejunostomy site, and anastomotic obstruction. The diagnosis was recurrent cancer in the remnant stomach with anastomotic obstruction. Although Master Ma was kept in the dark, his wife was terrified. The family had him hospitalized, and he underwent surgery again. During the operation, local mucosal erosion was found on the gastric wall, and a pitch-black mass was impacted at the anastomosis site. It was removed for pathological examination and diagnosed as a gastric bezoar. This showed that Master Ma did not have cancer, and the family was relieved of their mental burden. It turned out that half a year ago, Master Ma had eaten several persimmons at once. He felt very satisfied at the time and had no discomfort afterward. Who would have known that symptoms appeared half a year later, and he immediately联想到 a recurrence of cancer. It was not until the surgery that it was confirmed he had a gastric bezoar.
Gastric bezoars are formed when certain indigestible plant or animal components, hair, or some minerals are ingested and congeal into a mass in the stomach. The most common types are caused by persimmons, dates, and hawthorns. The formation of persimmon bezoars is generally attributed to the high tannin content in persimmons, which, under the action of gastric acid, forms insoluble precipitates that combine with pectin and food debris to form a clotted mass. Hawthorns are rich in pectin, which can gel under suitable pH conditions, forming stones in the stomach. Further research has confirmed that eating raw hawthorns on an empty stomach and then drinking tea, alcohol, or consuming foods that increase gastric acidity are the main precipitating factors for hawthorn bezoars. After a gastric bezoar forms, the main symptoms are upper abdominal pain and discomfort, bloating, loss of appetite, nausea, and vomiting. Some patients develop complications such as pyloric obstruction and upper gastrointestinal bleeding.
Compared to other stomach diseases, gastric bezoars are relatively rare, so they are often misdiagnosed when they occur. Misdiagnosis as gastric cancer can easily create a tense atmosphere and even lead to unnecessary surgery. In fact, diagnosing a gastric bezoar is not difficult. The key is for the patient to clearly and carefully explain their medical history to the doctor, especially their dietary habits and preferences, and what they have eaten recently. With a clear medical history, the doctor can follow the clues to make a correct diagnosis. In the past, the treatment of gastric bezoars mostly involved surgical methods. With the advancement of medical science, there are now multiple treatment options that can completely avoid surgery, such as recent methods like external abdominal massage and crushing, endoscopic laser-induced lithotripsy, mechanical lithotripsy, and oral Chinese and Western medicine treatments.