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Bezoars are tightly packed collections of partially digested or undigested material stuck in the stomach or other parts of the digestive tract. Foreign bodies are small ingested objects that can also get stuck in the digestive tract and sometimes perforate (pierce) it.
The stomach is a common collection site for hardened, partially digested or undigested masses of food or other materials (bezoars) or for foreign objects (bodies). Reasons include the curved shape of the stomach and the narrow opening (pyloric sphincter) that the stomach's contents must pass through to enter the first segment of the small intestine (duodenum). Bezoars or foreign bodies larger than ¾ of an inch (about 2 centimeters) in diameter are rarely able to pass out of the stomach.
Bezoars may consist of partially digested hair, fiber from fruits or vegetables, and even hardened blocks of drugs (such as antacids), which accumulate most often in the stomach but sometimes elsewhere in the digestive tract. These hairballs or foodballs cannot pass through narrow openings or spaces and thus get stuck in the digestive tract.
Foreign bodies are sometimes swallowed by children and even adults, especially intoxicated adults. If these undigestible objects are small, they pass through the digestive system until they are excreted with stool. However, larger objects or sharp ones, such as fish bones, may get stuck in the esophagus or stomach or, less often, in other parts of the digestive tract (see Anal and Rectal Disorders: Foreign Objects in the Rectum). Sometimes foreign bodies are swallowed purposely, as when smugglers swallow balloons filled with illegal drugs to get through customs.
Food or other materials can collect in anyone but do so more often under certain circumstances. People who have undergone surgery to their digestive tract, particularly if they have had part of their stomach or intestines removed, are particularly prone to bezoars and foreign bodies becoming stuck. People with diabetes sometimes develop a condition in which the stomach does not empty properly, resulting in problematic collections of food.
Symptoms and Diagnosis
Most bezoars and foreign bodies cause no symptoms.
A small blunt object that is swallowed may produce the sensation of something being stuck in the esophagus. This feeling may persist for a short time even after the object has passed into the stomach. A small sharp object that is swallowed may become lodged in the esophagus and cause pain, even though the person is able to swallow normally. When the esophagus is completely blocked, the person is unable to swallow anything, even saliva, and drools and spits constantly. The person may try to vomit, but nothing comes up. If a sharp object pierces the esophagus, consequences may be serious.
Sometimes bezoars or foreign bodies lead to blood in the stool. If they are partially or completely obstructing the stomach, the small intestine, or, rarely, the large intestine, they cause cramps, bloating, loss of appetite, vomiting, and sometimes fever. If a sharp object has pierced the stomach or intestines, stool spills into the area around the intestines, causing severe abdominal pain, fever, fainting, and sometimes shock. Such a leakage is a medical emergency because it can cause peritonitis (see Gastrointestinal Emergencies: Intestinal Obstruction). If a person has swallowed a drug-filled balloon, the balloon may rupture, which can then lead to an overdose of the drug.
Often, an obstructing object can be seen on x-rays of the abdomen. Sometimes, endoscopy (a visual examination of the digestive tract using a flexible tube called an endoscope—see Diagnosis of Digestive Disorders: Endoscopy) is performed to determine the nature of the obstructing object and to exclude a tumor as the cause. Rarely, computed tomography (CT) and ultrasonography are used to identify the problem.
Treatment
Most bezoars and foreign bodies require no treatment. Even a small coin is likely to pass without a problem. A doctor advises the person to check the stool to see when the object is excreted. Sometimes a doctor recommends that the person consume a liquid diet to help excrete the object.
To help break down a bezoar, a doctor may prescribe a regimen of cellulase or meat tenderizer, which is dissolved in a liquid and taken by mouth for several days. Sometimes doctors use forceps, a laser, or other instruments to break up bezoars so that they can pass through or be removed more easily.
When a doctor suspects that a blunt foreign body is stuck in the esophagus, the drug glucagon may be given intravenously to relax the esophagus and allow the object to pass through the digestive tract. Other drugs such as metoclopramide taken by mouth can help bezoars or blunt foreign objects pass through the digestive tract by causing muscles to contract.
Doctors can remove some objects that are stuck in the esophagus with forceps or a basket passed through an endoscope.
Because sharp objects may pierce the wall of the esophagus, they must be removed, either by endoscopy or surgery. Batteries are also removed from the esophagus because they can cause internal burns. When an object suspected of being a drug-filled balloon is detected, it is removed to prevent the drug overdose that can occur if such a balloon ruptures.
Last full review/revision June 2006 by Sidney Cohen, MD
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