PMC4835156_01
Transverse ultrasound image (A) showing a small bowel bezoarlet as curvilinear hyperechoic arc with posterior acoustic shadowing in a dilated jejunal loop (arrows) and the Doppler image (B) showing the lack of internal vascularity. Free fluid can also be seen (arrowheads).
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Similar, albeit smaller echogenic masses with prominent PAS were also seen in segments of dilated small gut loops (Figure 1A). Doppler USG did not reveal any abnormal internal vascularity (Figure 1B).
CT scout view of the abdomen (A) showing the gastric bezoar as a localized area of mottled lucencies with a peripheral crescent of air (arrows) and dilated air- filled small bowel loops in the mid abdomen (arrowheads). Coronal CT MPR image (B) showing the gastric bezoar (arrows) and multiple small bowel bezoarlets (zig-zag arrows)
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The CT scout view of the abdomen showed mottled radiolucencies in the stomach with a crescent of air in the periphery along with dilated jejunal loops (Figure 2A). The small bowel loops were dilated with presence of multiple (five) similar but smaller hypodense masses in the jejunum and ileum (Figure 2B, 3B).
Axial contrast- enhanced CT image (A) showing the gastric bezoar with air in the interstices and peripheral air crescent (arrows). Axial contrast- enhanced CT image at the level of the pelvis (B) showing the separate small bowel bezoarlets (arrowheads).
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The axial plain and contrast images showed an inhomogeneous attenuation hypodense non- enhancing mass 16x11x8 cm in size, occupying almost the entire stomach with pockets of air in the interstices (Figure 3A). The small bowel loops were dilated with presence of multiple (five) similar but smaller hypodense masses in the jejunum and ileum (Figure 2B, 3B).
Intraoperative photograph showing the gastric bezoar along the small bowel bezoarlets.
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A large trichobezoar was extracted from the stomach and the smaller bezoars were milked and extracted from the ileal enterotomy site (Figure 4).