A 4-Year-Old Post-Bariatric Surgery Suture-Bezoar

Case Presentation

A 48-year-old woman who had undergone a Roux-en-Y Gastric Bypass surgery 6 years ago presented to our clinic with a history of recurrent episodes of nausea, nonbilious vomiting, and abdominal pain that began 4 years ago and worsened in the last month. The symptoms were not exacerbated by meals or changes in position. Neither symptoms of headache nor vertigo were told. Prior to this, our patient visited clinicians for her complaints and had undergone multiple endoscopies, which only showed grade A gastroesophageal reflux and no physical obstruction was found. The most recent endoscopy also revealed contamination with Helicobacter pylori. Our patient had received appropriate medications for both problems. Upon her physical examination, only epigastric tenderness was noted. Laboratory tests and imaging showed a grade 2 fatty liver, but were otherwise normal. Motility tests, such as a gastric emptying scan, were not performed for the patient due to the limited availability of specialized clinical centers and the potential cost associated with the procedure. A decision was made to perform an endoscopy, during which a 40-mm bezoar was discovered attached to a nylon suture in the efferent loop of the bypass ([Fig. 1A–C]). After preparing for the procedure, the bezoar was removed endoscopically, first by cutting it with a snare and then retrieving the remaining suture and bezoar through multiple attempts until it was completely removed ([Fig. 1D]). In the follow-up after 4 months, the patient was in complete relief and no adverse event after gastroscopy was appeared.

Fig. 1 (A) Gastric bezoar extended from the suture in anastomosis in the efferent jejunal loop; the suture has acted as a nidus to trap undigested materials. (B) Extended suture in the efferent jejunal loop. (C) The 40-mm trapped suture-bezoar had made a partial obstruction in the jejunal loop. (D) Complete removal of 40-mm suture-bezoar; symptoms relieved after the procedure and the patient experienced no adverse effect.

 

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Practical Implications for Endoscopists

• Endoscopists should be aware of the potential for bezoar formation as a rare early or late complication in patients with a history of bariatric surgery.[1]

• Gastric surgery is a known risk factor for bezoar formation, as it can alter motility and decrease gastrointestinal (GI) secretion, both of which increase the risk of bezoar aggregation. As a result, surgeons should be mindful of the materials used in the GI lumen and avoid leaving suture remnants, as they can serve as nidus for bezoar formation.[2]

• Chemical dissolution is commonly the preferred approach for treating bezoars due to its practicality and cost-effectiveness. However, it may not be suitable for all types and sizes of bezoars, particularly phytobezoars and trichobezoars.[3] In such cases, endoscopic therapy using various fragmentation methods can be a low-risk, outpatient, and noninvasive alternative. Surgery is typically recommended for larger bezoars and patients who failed to respond with other treatment options.[1] [2]

 

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Conflict of Interest

None declared.

Authors' Contributions

Conception and design, critical revision of the article for important intellectual content, and final approval of the article: H.M. Collection of data and drafting of the article: F.A.B. All authors approved the final version of the manuscript and agree to be accountable for all aspects of this work.

Ethical Approval

All human studies have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its subsequent amendments.

• References

• 1 Ben-Porat T, Sherf Dagan S, Goldenshluger A, Yuval JB, Elazary R. Gastrointestinal phytobezoar following bariatric surgery: Systematic review. Surg Obes Relat Dis 2016; 12 (09) 1747-1754
• 2 Paschos KA, Chatzigeorgiadis A. Pathophysiological and clinical aspects of the diagnosis and treatment of bezoars. Ann Gastroenterol 2019; 32 (03) 224-232
• 3 Niţă AF, Hill CJ, Lindley RM, Marven SS, Thomson MA. Human and Doll's hair in a gastric trichobezoar, endoscopic retrieval hazards. J Pediatr Gastroenterol Nutr 2020; 71 (02) 163-170

Publikationsverlauf

Artikel online veröffentlicht:
08. September 2025