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Fulltext Stomach trichobezoar (rapunzel syndrome) with iatrogenic intussusception

Yik YI, How AK

Med J Malaysia, 2016 04;71(2):74-6.
PMID: 27326947 MyJurnal

We present a rare case of stomach trichobezoar complicated with iatrogenic intussusception noted intra-operatively after failed attempt of endoscopic removal in a 13-year-old girl. At presentation, she had gastric outlet obstruction with anaemia. Endoscopy established the diagnosis of trichobezoar. Surgical removal was warranted after failed endoscopic removal. Her postoperative course was uneventful. Detailed history and careful examination disclosed trichotillomania and associated trichophagia. Psychiatric referral was sought with the intention to prevent future recurrence.

Matched MeSH terms: Bezoars/diagnosis*; Bezoars/etiology; Bezoars/surgery
Rubber cast of stomach produced by latex ingestion

Yusof Said M, Goh Tin Kay

Med J Malaysia, 1973 Sep;28(1):52-4.
PMID: 4273787
Matched MeSH terms: Bezoars/diagnosis
Phytobezoar: a case report

Chellappa M, Ahmad K

Med J Malaysia, 1978 Mar;32(3):245-6.
PMID: 683051
Matched MeSH terms: Bezoars/surgery*
Mushroom Bezoar Causing Small Bowel Obstruction

Hamzah AA, Keow CK, Syazri A, Mallhi TH, Khan AH, Khan YH, et al.

J Coll Physicians Surg Pak, 2017 Mar;27(3):S13-S15.
PMID: 28302231 DOI: 238

A bezoar is a concretion of foreign or indigestible matter in the alimentary canal and is usual cause of gastric obstruction. Bezoars can become fragmented and migrate downward leading to intestinal obstruction. Diagnosis of phytobezoar has become challenging in clinical practice due to lack of patient history and inability of patient to correlate preceding events with the episode of bowel obstruction. Bezoar associated small bowel obstruction rarely occurs and is usually found in patients with history of gastrointestinal surgery. Very few cases are reported of small bowel obstruction due to bezoar in healthy population without prior illness or surgery. We present a case of small bowel obstruction due to mushroom bezoar in a 62-year patient with no past history of medical illness or gastric surgery. Enterotomy was performed and a whole piece of undigested mushroom measuring 5 x 3 cm was successfully removed.

Matched MeSH terms: Bezoars/complications*; Bezoars/diagnosis*; Bezoars/surgery
Fulltext A 'Hairy' problem: Trichotillomania, trichophagia and trichobezoars

Yik YI, How AK

Singapore Med J, 2016 Jul;57(7):411.
PMID: 27439704 DOI: 10.11622/smedj.2016125
Matched MeSH terms: Bezoars/surgery*
Fulltext Phytobezoar: an unusual cause of intestinal obstruction

Teng H, Nawawi O, Ng K, Yik Y

Biomed Imaging Interv J, 2005 Jul;1(1):e4.
PMID: 21625276 MyJurnal DOI: 10.2349/biij.1.1.e4

Small bowel phytobezoars are rare and almost always obstructive. There have been previously reported cases of phytobezoars in the literature, however there are few reports on radiological findings for small bowel bezoars. Barium studies characteristically show an intraluminal filling defect of variable size that is not fixed to the bowel wall with barium filling the interstices giving a mottled appearance. On CT scan, the presence of a round or ovoid intraluminal mass with a 'mottled gas' pattern is believed to be pathognomonic. Since features on CT scans are characteristics and physical findings are of little assistance in the diagnosis of bezoar, the diagnostic value of CT needs to be emphasised.

Matched MeSH terms: Bezoars
Fulltext The girl with rapunzel syndrome

Norly, S., Noor Saadah, I., Ros'aini, P.

International Medical Journal Malaysia, 2015;14(1):99-101.
MyJurnal

Rapunzel syndrome is a syndrome whereby a gastric trichobezoar (hair ball) extends through the pylorus, in the form of a long tail, to cause gastric outlet obstruction. It was first described by Vaughan et al. in 1968. The syndrome is mostly seen in young females with psychiatric illness. Presentations can be non-specific especially in the early stages. If left untreated it may leads to severe complications, which may include gastric ulceration, intestinal obstruction, perforated viscus and obstructive jaundice. Treatment is essentially surgical and psychi- atric consultation is necessary to prevent relapses. We present the case of a 26-year-old mentally subnormal lady with gastric trichobezoar and provide a review of the literature.

Matched MeSH terms: Bezoars
Fulltext Gastric trichobezoar in an end-stage renal failure and mental health disorder presented with chronic epigastric pain: A case report

Ali AA, Gurung R, Fuad ZM, Moosa M, Ali I, Abdulla A, et al.

Ann Med Surg (Lond), 2020 Oct;58:76-79.
PMID: 32953103 DOI: 10.1016/j.amsu.2020.08.021

Background: Gastric trichobezoar happens when there is an indigestible substance or food found in the gastrointestinal tract. It is a rare presentation which is usually associated with trichotillomania and trichopagia. The presentation may not be specific and is usually related to dyspepsia-like symptoms. In the worst-case scenario, this may cause gastric outlet or intestinal obstruction which eventually requires surgery.
Case presentation: We present a 36-year-old lady with underlying end-stage renal failure (ESRF) and undiagnosed mental health issues who was treated for recurrent episodes of gastritis. Imaging modalities revealed intragastric foreign body ingestion which is consistent with gastric trichobezoar. She eventually underwent laparotomy and gastrotomy to remove the foreign body. Postoperatively, she was referred and followed-up by the psychiatric team.
Conclusion: Gastric trichobezoar has strong associations with psychiatric disorders. With the co-existence of an ESRF, uraemia might contribute to the aetiology of the trichotillomania and trichophagia. Open surgery is the choice of definitive management especially if bezoars are larger. Should the recurrence be remitted, a biopsychosocial modality and regular haemodialysis is the most sustainable approach to ensure the behaviour does not persist.

Matched MeSH terms: Bezoars
Fulltext Anti-proliferative property of porcupine bezoar extract on melanoma (A375)

Al’aina Yuhainis Firus Khan, Faizah Abdullah Asuhaimi, Tara Jalal, Hatim Abdullah Natto, Opeyemi Roheem, Fatimah, Qamar Uddin Ahmed, et al.

International Journal of Allied Health Sciences, 2017;1(2):1-13.
MyJurnal

Porcupine bezoar (PB) has been previously reported to possess various medicinal properties. However, its potential as an anticancer agent against human cancers is still poorly studied and understood. Hence, in this study, porcupine bezoar (PB) aqueous extract was evaluated for its potential as a safe anticancer agent. Initially PB was infused in water for 18 h to get PB aqueous extract which was preliminary tested for total phenolic content (TPC), total flavonoid content (TFC), DPPH activity in order to confirm the presence of bioactive agents as antioxidants in PB. Later, PB aqueous extract was subjected to A375 (Melanoma) (IC50, cell proliferation assay) and HGF-1
(normal cell, for cytotoxicity assay) to evaluate its anticancer potential. PB aqueous extract showed 11.68 μg/mL ± 0.67 TPC value expressed as gallic acid equivalents while TFC was not detected confirming the absence of flavonoids in PB aqueous extract. IC50 for DPPH was found to be 0.79 μg/mL ± 0.07. The IC50 result for A375 was found to be 10.1 µg/mL ± 0.17. PB aqueous extract showed significant antiproliferation pattern at 24, 48 and 72 hours exposures. The data from this study suggest the potential alternative use of PB in developing natural antioxidants and antiproliferative agents for improving human health.

Matched MeSH terms: Bezoars
Fulltext Rapunzel syndrome in a paediatric patient

Ngo, C.W., Syauki, H., Kumar, M.V.

Journal of Surgical Academia, 2017;7(1):66-68.
MyJurnal

Rapunzel syndrome, or generically known as trichobezoar, is a rare condition. It usually happens among teenage population. We are presenting a case report of Rapunzel syndrome that happened in a 4-year-old child. She was initially investigated for nephrotic syndrome, as she had high blood pressure and hypoalbuminaemia. However, it was later found out to be a trichobezoar, indirectly causing both hypertension and malnutrition. This condition demanded a combination of surgical and psychiatric discipline for diagnosis and its treatment.

Matched MeSH terms: Bezoars
Determination toxic effects of Hystrix Brachyura Bezoar extracts using cancer cell lines and embryo zebrafish (Danio rerio) models and identification of active principles through GC-MS analysis

Firus Khan AY, Ahmed QU, Nippun TS, Hilles A, Jalal TK, Teh LK, et al.

J Ethnopharmacol, 2020 Nov 15;262:113138.
PMID: 32726681 DOI: 10.1016/j.jep.2020.113138

ETHNOPHARMACOLOGICAL RELEVANCE: Porcupine bezoar (PB) is used as folk medicine for various medical conditions including cancer treatment in Malaysia. However, its toxicity profile has never been thoroughly ascertained to confirm its safe nature as an efficacious traditional medicine in the treatment of cancer as well as other ailments.
AIM OF THE STUDY: This study was aimed to reveal three different PBs' aqueous extracts(viz. PB-A, PB-B, PB-C) chemical constituent's profile using GC-MS analysis, anticancer property on A375, HeLa and MCF7 cancer cells, toxicity profile on zebrafish embryo morphology, EC50, LC50 and teratogenicity index.
MATERIALS AND METHODS: PBs' extracts characterization was performed through GC-MS analysis, in vitro anticancer effect was carried out on A375, HeLa and MCF7 cancer cell lines and finally and toxicity properties on three different PBs aqueous extracts (viz. PB-A, PB-B, PB-C) were determined using zebrafish embryo model.
RESULTS: The GC-MS analysis revealed 10 similar compounds in all PBs' extracts. Dilauryl thiodipropionate was found to be a major compound in all PBs' extracts followed by tetradecanoic acid. An in vitro anticancer study revealed PB extracts exerted median inhibition concentration (IC50) <50 μg/mL, on cancer cells viz. A375, HeLa and MCF7 with no significant toxicity on normal cells viz. NHDF cells. In vivo toxicity of PBs extracts found affecting tail detachment, hatching, craniofacial, brain morphology, soft tissues, edema, spinal, somites, notochord and cardiovascular system (brachycardia, disruption of blood circulation) deformities. The LC50 and EC50 demonstrated PB extracts effect as dose and time dependent with median concentration <150.0 μg/mL. Additionally, teratogenicity index (TI) viz. >1.0 revealed teratogenic property for PB extracts.
CONCLUSIONS: The findings revealed that all three PBs aqueous extracts possessed anticancer activity and exhibited significant toxicological effects on zebrafish embryos with high teratogenicity index. Hence, its use as an anticancer agent requires further investigation and medical attentions to determine its safe dose.

Matched MeSH terms: Bezoars*
Fulltext Anticancer activity of grassy Hystrix brachyura bezoar and its mechanisms of action: An in vitro and in vivo based study

Khan AYF, Ahmed QU, Narayanamurthy V, Razali S, Asuhaimi FA, Saleh MSM, et al.

Biomed Pharmacother, 2019 Jun;114:108841.
PMID: 30981106 DOI: 10.1016/j.biopha.2019.108841

Porcupine bezoar (PB) is a calcified undigested material generally found in porcupine's (Hystrix brachyura) gastrointestinal tract. The bezoar is traditionally used in South East Asia and Europe for the treatment of cancer, poisoning, dengue, typhoid, etc. However, limited scientific studies have been performed to verify its anticancer potential to substantiate its traditional claims in the treatment of cancers. Hence, this study was aimed at investigating the in vitro and in vivo anticancer properties of two grassy PB aqueous extract (PB-A and PB-B) using A375 cancer cell line and zebrafish model, respectively. This paper presents the first report on in vitro A375 cell viability assay, apoptosis assay, cell cycle arrest assay, migration assay, invasion assay, qPCR experimental assay and in vivo anti-angiogenesis assay using the grassy PBs. Experimental findings revealed IC50 value are 26.59 ± 1.37 μg/mL and 30.12 ± 3.25 μg/mL for PB-A and PB-B respectively. PBs showed anti-proliferative activity with no significant cytotoxic effect on normal human dermal fibroblast (NHDF). PBs were also found to induce apoptosis via intrinsic pathway and arrest cell cycle at G2/M phase. Additionally, the findings indicated its ability to debilitate migration and invasion of A375 cells. Further evaluation using embryo zebrafish model revealed LC50 = 450.0 ± 2.50 μg/mL and 58.7 ± 5.0 μg/mL for PB-A and PB-B which also exerted anti-angiogenesis effect in zebrafish. Moreover, stearic acid, ursodeoxycholic acid and pregnenolone were identified as possible metabolites that might contribute to the anticancer effect of the both PBs. Overall, this study demonstrated that PB-A and PB-B possess potential in vitro and in vivo anticancer effects which are elicited through selective cytotoxic effect, induction of apoptosis, inhibition of migration and invasion and anti-angiogenesis. This study provides scientific evidence that the porcupine bezoar do possess anti-cancer efficacy and further justifies its traditional utility. However, more experiments with higher vertebrae models are still warranted to validate its traditional claims as an anticancer agent.

Matched MeSH terms: Bezoars/metabolism*