Rare case of obstructive duodenal phytobezoar caused
by two lipomas
Eunae CHO ,* Chung Hwan JUN,* Eun Kyu PARK,
Chang Hwan PARK,* Hyun Soo KIM,* Sung Kyu CHOI*
& Jong Sun REW*
*Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, and
Department of Surgery, Chonnam National University Medical School, Gwangju, South Korea
The term ‘bezoar’ comes from either the Persian word
‘padzahr’ or the Arabic word ‘badzehr’, both of which
denote ‘antidote.’ This word meant a hard stone
found in the stomach of the Syrian goat and was
believed to prevent poisoning.
Today, bezoar is
applied to indigestible conglomerations found in the
gastrointestinal (GI) tract. Bezoars are classiﬁed
according to their main components. The most com-
mon type, a phytobezoar, consists of vegetable and
fruit ﬁber. A trichobezoar consists of hair, a pharma-
cobezoar of medications, and a lactobezoar is caused
by milk products.
Bezoars are usually found in the
stomach but occasionally occur in the ileum and jeju-
num. Primary duodenal bezoars are rare.
bezoars are managed with chemical dissolution,
endoscopic removal or surgery. However, when
bezoar-induced intestinal obstruction occurs, surgery
is usually performed.
Lipomas of the GI tract are benign, usually single,
slow-growing tumors originating from the submucosa.
They are found incidentally in most cases and occur
most commonly in the colon, ileum and jejunum.
Duodenal lipomas are relatively rare and are usually
found in the second part of the duodenum. GI
lipomas are usually asymptomatic but may cause
However, to our knowledge, primary
duodenal bezoars associated with duodenal lipomas
have not been reported.
Here we report a case of primary duodenal phytobe-
zoar caused by two lipomas at the third quarter of
the duodenum, all of which were successfully
removed using endoscopic fragmentation and endo-
scopic mucosal resection (EMR).
A 75-year old woman presented to our hospital with
a 1-week history of epigastric pain and worsening
postprandial vomiting. Hematemesis, melena and
fever were absent. On admission, her pulse, blood
pressure, respiratory rate and temperature were a reg-
ular 70 beats/min, 130/80 mmHg, 20 breaths/min
C, respectively. She had been taking a cal-
cium channel blocker, aspirin and hydrochlorothia-
zide for hypertension for 15 years. She had no other
signiﬁcant medical illness and had never undergone
GI surgery. On physical examination, her abdomen
was distended but soft to palpation. Mild epigastric
tenderness without rebound tenderness was noted,
and shifting dullness was absent. A rectal examina-
tion demonstrated no melena or anal mass. The chest
X-ray was unremarkable and abdominal X-ray
showed gastric and duodenal distension. Laboratory
tests demonstrated a normal white blood cell count,
hemoglobin and platelet count. Her liver and renal
function tests, coagulation proﬁle and C-reactive pro-
tein level were within normal limits. A computed
tomography scan of the abdomen and pelvis demon-
strated marked gastric and proximal duodenal
Correspondence to: Jong Sun REW, Division of Gastroenterology,
Department of Internal Medicine, Chonnam National University
Hospital, Jebongro 42, Gwangju, South Korea. Email: firstname.lastname@example.org
Conﬂict of interest: None.
Accepted for publication 12 July 2017.
© 2017 Chinese Medical Association Shanghai Branch, Chinese
Society of Gastroenterology, Renji Hospital Afﬁliated to Shanghai
Jiaotong University School of Medicine and John Wiley & Sons
Journal of Digestive Diseases 2018; 19; 48–51 doi: 10.1111/1751-2980.12508