Bezoars in children: Report of four cases

We reviewed the histories of four children (2 boys and 2 girls, aged 6 mo t o 10 yr) with surgically proven bezoars, treated from 1991 to 1998. Two had gastric bezoars and mio had intestinal bezoars. All four patients presente d with gastrointestinal symptoms and none had undergone previous surgery. T hree had a history of abnormal ingestion, including one who ate a pickled f ruit from the Boraginaceae (locally known as Po-pu-tsu) plant for 1 year. P lain radiographs revealed intestinal obstruction in all four patients. Abdo minal sonography disclosed a hyperechoic band-like lesion and acoustic shad ow in both cases of gastric bezoar, and these bezoars were subsequently con firmed by gastric endoscopy. Lower gastrointestinal studies showed obstruct ion considered most likely to be due to bezoar in one case, while computed tomography (CT) revealed a characteristic small bowel mottled gas pattern i n another. Surgical treatment relieved obstruction in all four patients. Be zoar should be suspected in patients with intestinal obstruction who have a history of ingestion of unusual substances. The findings of this report su ggest that sonography and endoscopy are useful in the diagnosis of gastric bezoar, while CT is useful in the detection of intestinal bezoar.