Gastric Miscellaneous ,El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy
Extrinsic compression due to malign ascites. This 34 year-old male that, two years previously was diagnosed as having colon cancer, now present a severe abdominal bulking due to a malign ascites.

Video Endoscopic Sequence 1 of 10.

Extrinsic compression due to malign ascites

 This 34 year-old male that, two years previously was
 diagnosed as having colon cancer, now present a severe
 abdominal bulking due to a malign ascites. 

 For more endoscopic details download the video clips by
 clicking on the endoscopic images, wait to be downloaded
 complete then press Alt and Enter; thus you can observe
 the video in full screen.

 All endoscopic images shown in this Atlas contain
 video clips.
At the gastric fundus is observed two extrinsic compression

Video Endoscopic Sequence 2 of 10.

 At the gastric fundus is observed two extrinsic compression
In order to relief the ascites a transgastric procedure was performed, first a pre-cut needle was used through an duodenoscope..

Video Endoscopic Sequence 3 of 10.

 In order to relief the ascites a transgastric procedure was
 performed, first a pre-cut needle was used through an
 duodenoscope.

After the gastric walls was opened a hydrostatic balloon was used to dilate the small hole.

Video Endoscopic Sequence 4 of 10.

 After the gastric walls was opened a hydrostatic balloon
 was used to dilate the small hole.

The gastric wall was open using a sphincterotome, the video clip shows the ascites draining across the gastric wall, the Intra-abdominal pressure was relief.

Video Endoscopic Sequence 5 of 10.

 The gastric wall was open using a sphincterotome, the video
 clip shows the ascites draining across the gastric wall, the
 Intra-abdominal pressure was overcome.
A pulsatile bleeding emerging from the gastric wall.

Video Endoscopic Sequence 6 of 10.

A pulsatile bleeding emerging from the gastric wall.

 
To perform the hemostasis the argon plasma coagulator was used combined with the absolute alcohol.

Video Endoscopic Sequence 7 of 10.

 To perform the hemostasis the argon plasma coagulator
 was used combined with the absolute alcohol.
Injection therapy with absolute alcohol.

Video Endoscopic Sequence 8 of 10.

 Injection therapy with absolute alcohol.
After the gastric wall is open, a transgastric endoscopic access of the peritoneal cavity is seen in the video clip.

Video Endoscopic Sequence 9 of 10.

 After the gastric wall is open, a transgastric endoscopic
 access of the peritoneal cavity is seen in the video clip.

 

 
A Tran gastric periteneoscopy, a part of the peritoneal cavity is observed. This transgastric periteneoscopy, is one of the first performed in a human beings.

Video Endoscopic Sequence 10 of 10.

A transgastric periteneoscopy, a part of the peritoneal
 cavity is observed.

 
Gastric Carcinoid Tumor. Carcinoids are the most common neuroendocrine tumors. The tumor is derived from primitive stem cells in the gut wall but can be seen in the liver, pancreas, bronchus, and ovaries. In children, most cases occur in the appendix, and most are benign and asymptomatic.

Video Endoscopic Sequence 1 of 8.

Gastric Carcinoid Tumor.

 Carcinoids are the most common neuroendocrine tumors.
 The tumor is derived from primitive stem cells in the gut
 wall but can be seen in the liver, pancreas, bronchus, and
 ovaries. In children, most cases occur in the appendix, and
 most are benign and asymptomatic.
Gastric Carcinoid Tumor. These tumors have a yellow, tan, or gray-brown appearance that can be observed through the intact mucosa. The yellow color is a result of cholesterol and lipid accumulation within the tumor. Tumors can have a polypoid appearance and occasionally can ulcerate.

Video Endoscopic Sequence 2 of 8.

Gastric Carcinoid Tumor.

 These tumors have a yellow, tan, or gray-brown appearance
 that can be observed through the intact mucosa. The yellow
 color is a result of cholesterol and lipid accumulation within
 the tumor. Tumors can have a polypoid appearance and
 occasionally can ulcerate.

 Similar images of Duodenal Carcinoid Tumor are found in
 duodenal miscellaneous chapter.

Gastric Carcinoid Tumor.

Video Endoscopic Sequence 3 of 8.

Gastric Carcinoid Tumor.
Gastric Carcinoid Tumor. Indigo Carmin Stain.

Video Endoscopic Sequence 4 of 8.

Gastric Carcinoid Tumor.

Indigo Carmin Stain.
Cromogranina.

Video Endoscopic Sequence 5 of 8.

  Cromogranina.

 
Gastric Carcinoid Tumor. At low power there is an intramucosal neoplasia.

Video Endoscopic Sequence 6 of 8.

4x.

 Gastric Carcinoid Tumor.

 At low power there is an intramucosal neoplasia.

 
Carcinoid Tumor. At medium power the organoid neoplasia replace the gastric glands. carcinoid tumor.

Video Endoscopic Sequence 7 of 8.

  10x.

Carcinoid Tumor.

 At medium power the organoid neoplasia replace the
 gastric glands. carcinoid tumor.

 
40x. The appendix is the most common site of gut carcinoid tumor, followed by the small intestine, rectum, stomach and ileum. Carcinoid tumor are potentially malignant and the tendency of malignant behavior correlate with the site of origin, the depth of local penetration and the size of the tumor.

Video Endoscopic Sequence 8 of 8.

40x.

 The appendix is the most common site of gut carcinoid
 tumor, followed by the small intestine, rectum, stomach and
 ileum.
 Carcinoid tumor are potentially malignant and the tendency
 of malignant behavior correlate with the site of origin, the
 depth of local penetration and the size of the tumor.

PostGastrectomyBiopsyBleed1

Video Endoscopic Sequence 1 of 7.

Severe Bleeding After Biopsies

 A 91 year-old male 10 years before underwent a subtotal
 gastrectomy due to gastric adenocarcinoma of the antrum
 recently appeared a mass in the pancreato-biliary tree
 causing jaundice, An endoscopy is performed to looking for
 tumor regression, near the gastro-jejuno anastomosis had
 an elevated area that it looks like a scar, multiple biopsies
 were taken with jumbo forceps causing severe bleeding..
PostGastrectomyBiopsyBleed2

Video Endoscopic Sequence 2 of 7.

The bleeding was of severe intensity, at the beginning we used argon plasma coagulator.

PostGastrectomyBiopsyBleed3

Video Endoscopic Sequence 3 of 7.

 The argon plasma coagulator was not enough, as it was a
 large caliber vessel, at this time we made the choice to use
 between the dual-channel therapeutic endoscope with
 argon plasma using therapeutic probe (larger caliber) or
 infiltrate this vessel with absolute alcohol, deciding for the
 latter.
PostGastrectomyBiopsyBleed4

Video Endoscopic Sequence 4 of 7.

 Injection of absolute alcohol was used in the area of the
 vessel but also was no successful.

 
PostGastrectomyBiopsyBleed5

Video Endoscopic Sequence 5 of 7.

After using the two therapies for hemostatic maneuver, a hemoclip was applied succeeding in stopping the bleeding

 
PostGastrectomyBiopsyBleed6

Video Endoscopic Sequence 6 of 7.

Final State of hemostatic therapy

 
PostGastrectomyBiopsyBleed7

Video Endoscopic Sequence 7 of 7.

Another image and video clip of Final State of hemostatic therapy.

 Important Comments: In the professional practice in
 almost all therapeutic procedures there are risks of
 complications as in this case that there was a need of
 taking biopsies taken as large forceps small malignant
 lesions often are not demonstrated by the shortage of
 tissues which is recommended to obtain macro-biopsies
 but these can take the risk of bleeding in this case, but
 success of this profession is to manage the
 complications with certainty, having multiple resources
 in hand as therapeutic and ablative therapies and
 homeostatic, the endoscopist should have adequate training
 and courage as well as the assistants.
Watermelon Stomach, longitudinal erythymatous stripes that formed lines within the antrum radiating towards the pylorus resembling the stripes of a watermelon and hence the name gastric antral vascular ectasias (GAVE), or watermelon stomach. Painless occult gastrointestinal bleeding with anemia in an elderly woman is the most typical presentation. This lesion is amenable to endoscopic thermal ablation, and the lesion shown was treated by argon plasma coagulation.

Video Endoscopic Sequence 1 of 7.

Watermelon Stomach

 Longitudinal erythymatous stripes that formed lines within
 the antrum radiating towards the pylorus resembling the
 stripes of a watermelon and hence the name gastric antral
 vascular ectasias (GAVE), or watermelon stomach.

 Painless occult gastrointestinal bleeding with anemia in an
 elderly woman is the most typical presentation. This lesion
 is amenable to endoscopic thermal ablation, and the lesion
 shown was treated by argon plasma coagulation.
Treatment of watermelon stomach (GAVE syndrome) with endoscopic argon plasma coagulation (APC). The diagnosis is based on the endoscopic findings. The typical lesions have longitudinal rugal folds traversing the antrum and converging on the pylorus, each containing a visible convoluted column of vessels, the aggregate resembling the stripes of a watermelon. Although these lesions are confined to the antrum in the majority of cases, up to 33% of the patients have proximal gastric involvement typically in the presence of a diaphragmatic hernia. It is important to emphasize, however, that these lesions might be misdiagnosed as gastritis or portal gastropathy and thus delay in treatment could result.

Video Endoscopic Sequence 2 of 7.

 Treatment of watermelon stomach (GAVE syndrome) with
 endoscopic argon plasma coagulation (APC).

 The diagnosis is based on the endoscopic findings. The
 typical lesions have longitudinal rugal folds traversing the
 antrum and converging on the pylorus, each containing a
 visible convoluted column of vessels, the aggregate
 resembling the stripes of a watermelon. Although these
 lesions are confined to the antrum in the majority of cases,
 up to 33% of the patients have proximal gastric
 involvement typically in the presence of a diaphragmatic
 hernia. It is important to emphasize, however, that these
 lesions might be misdiagnosed as gastritis or portal
 gastropathy and thus delay in treatment could result.
Watermelon stomach is an increasingly recognizable cause of persistent acute or occult gastrointestinal bleeding, especially in elderly women. The chief presentation is severe iron deficiency anemia and occult or overt gastrointestinal bleeding. Diagnosis is made on endoscopy by the characteristic appearance of visible watermelon linear stripes in the antrum. Histology is rarely needed to confirm the diagnosis. The importance of this lesion lies in the proper recognition since it is amenable to successful therapeutic interventions, leading to endoscopic healing of the lesion, significant improvement in the anemia and a reduction in the need for blood transfusions.

Video Endoscopic Sequence 3 of 7.

 Watermelon stomach is an increasingly recognizable cause
 of persistent acute or occult gastrointestinal bleeding,
 especially in elderly women. The chief presentation is
 severe iron deficiency anemia and occult or overt
 gastrointestinal bleeding. Diagnosis is made on endoscopy
 by the characteristic appearance of visible watermelon
 linear stripes in the antrum. Histology is rarely needed to
 confirm the diagnosis. The importance of this lesion lies in
 the proper recognition since it is amenable to successful
 therapeutic interventions, leading to endoscopic healing of
 the lesion, significant improvement in the anemia and a
 reduction in the need for blood transfusions.
The argon-plasma-coagulation uses instead of laser energy conduction of electric energy by ionized argon gas (plasma), which produces coagulation necrosis of tissues. The potential advantages of the argon-plasma-coagulation lie in the limited deep penetration, which reduces the risk of perforation and the symmetric spread of the coagulation effects in the surrounding mucosa. These properties make the argon plasma-coagulation a promising tool for the endoscopic therapy of mucosal lesions of the GI-tract. Further attractive is the low cost of the argon-plasma-coagulation equipment compared with laser devices.

Video Endoscopic Sequence 4 of 7.

 The argon-plasma-coagulation uses instead of laser energy
 conduction of electric energy by ionized argon gas (plasma),
 which produces coagulation necrosis of tissues. The
 potential advantages of the argon-plasma-coagulation lie in
 the limited deep penetration, which reduces the risk of
 perforation and the symmetric spread of the coagulation
 effects in the surrounding mucosa. These properties make
 the argon plasma-coagulation a promising tool for the
 endoscopic therapy of mucosal lesions of the GI-tract.
 Further attractive is the low cost of the argon-plasma
 -coagulation equipment compared with laser devices.
The therapeutic options are numerous for this condition and needs to be individualized. The simplest form of therapy is iron supplementation and occasional blood transfusions. When these measures fail, other approaches are warranted, including endoscopic, pharmacologic or surgical therapies.

Video Endoscopic Sequence 5 of 7.

 The therapeutic options are numerous for this condition and
 needs to be individualized. The simplest form of therapy is
 iron supplementation and occasional blood transfusions.
 When these measures fail, other approaches are warranted,
 including endoscopic, pharmacologic or surgical therapies.
 

 
Argon Plasma Coagulator is a new device that allows for non-contact monopolar coagulation of bleeding surfaces, and devitalization of tissue in the gastrointestinal tract. It is safer and much less expensive than lasers, more effective than bipolar cauterization techniques.

Video Endoscopic Sequence 6 of 7.

 Argon Plasma Coagulator is a new device that allows for
 non-contact monopolar coagulation of bleeding surfaces,
 and devitalization of tissue in the gastrointestinal tract. It is
 safer and much less expensive than lasers, more effective
 than bipolar cauterization techniques.
The electrode in the argon channel of the probe is connected to an electrosurgical generator. The APC probe ionizes the argon gas where it remains ionized approximately 2-10mm distal to the tip of the probe. Ionized Argon gas is electrically conductive. This allows the current to flow between the probe and the tissue. Current density upon arrival at the tissue surface causes coagulation. The application of the energy to the tissue is uniform, and contact free. The Argon plasma beam acts not only in a straight line (axially) along the axis of the probe, but also laterally and radially and "around the corner" as it seeks conductive bleeding surfaces. Following physical principles, the plasma beam has a tendency to turn away from already coagulated (high impedance) areas toward bleeding or still inadequately coagulated receiving treatment. This automatically results in evenly applied , uniform surface coagulation.

Video Endoscopic Sequence 7 of 7.

 The electrode in the argon channel of the probe is
 connected to an electrosurgical generator.

 The APC probe ionizes the argon gas where it remains
 ionized approximately 2-10mm distal to the tip of the probe.
 Ionized Argon gas is electrically conductive. This allows the
 current to flow between the probe and the tissue. Current
 density upon arrival at the tissue surface causes
 coagulation. The application of the energy to the tissue is
 uniform, and contact free. The Argon plasma beam acts not
 only in a straight line (axially) along the axis of the probe,
 but also laterally and radially and "around the corner" as it
 seeks conductive bleeding surfaces. Following physical
 principles, the plasma beam has a tendency to turn away
 from already coagulated (high impedance) areas toward
 bleeding or still inadequately coagulated receiving
 treatment. This automatically results in evenly applied,
 uniform surface coagulation.
Watermelon-stomach is a rare cause of gastrointestinal bleeding. There has been an increasing number of reports on the association of this lesion with diseases of the scleroderma group. Gastric antral vascular ectasia (GAVE), also referred to as Watermelon stomach, is a severe haemorrhagic condition that leads to significant morbidity and transfusion dependence in some patients. Re-bleeding following treatment is common, and there are few treatment options. Until recent treatment modalities were developed, the only options available to patients were blood transfusions or the surgical removal of the stomach (antrectomy). The estimated prevalence of GAVE ranges from 0.3 per cent of cases in a large endoscopic series to 4 per cent in highly selected cohorts with severe gastrointestinal bleeding. Although some patients with diffuse GAVE may have portal hypertensive gastropathy, for the purpose of this application the indication is GAVE not related to portal hypertensive gastropathy.

Watermelon Stomach

 Watermelon-stomach is a rare cause of gastrointestinal
 bleeding. There has been an increasing number of reports
 on the association of this lesion with diseases of the
 scleroderma group.

 Gastric antral vascular ectasia (GAVE), also referred to as
 Watermelon stomach, is a severe haemorrhagic condition
 that leads to significant morbidity and transfusion
 dependence in some patients. Re-bleeding following
 treatment is common, and there are few treatment options.
 Until recent treatment modalities were developed, the only
 options available to patients were blood transfusions or the
 surgical removal of the stomach (antrectomy). The
 estimated prevalence of GAVE ranges from 0.3 per cent of
 cases in a large endoscopic series to 4 per cent in highly
 selected cohorts with severe gastrointestinal bleeding.
 Although some patients with diffuse GAVE may have portal
 hypertensive gastropathy, for the purpose of this
 application the indication is GAVE not related to portal
 hypertensive gastropathy.
Upside-down stomach, Gastric Rotation, The term "gastric volvulus" is reserved for cases in which the abnormal rotation has led to strangulation and obstruction Gastric volvulus is defined as an abnormal rotation of the stomach of more than 180°, creating a closed loop obstruction that can result in incarceration and strangulation. The stomach can rotate along an axis that is 90° to the longitudinal axis. Such rotation is called a mesenteroaxial rotation . This rotation may lead to an upside-down stomach. Mesenteroaxial rotation of an intrathoracic stomach is less common than organoaxial rotation. Mesenteroaxial rotation is more frequently seen in patients with progression of a type 2 paraesophageal hiatal hernia.

Video Endoscopic Sequence 1 of 3.

Upside-Down Stomach

 (Gastric Rotation)

 The term "gastric volvulus" is reserved for cases in which
 the abnormal rotation has led to strangulation and
 obstruction Gastric volvulus is defined as an abnormal
 rotation of the stomach of more than 180°, creating a
 closed loop obstruction that can result in incarceration and
 strangulation.

 The stomach can rotate along an axis that is 90° to the
 longitudinal axis. Such rotation is called a mesenteroaxial
 rotation . This rotation may lead to an upside-down
 stomach.
 Mesenteroaxial rotation of an intrathoracic stomach is less
 common than organoaxial rotation. Mesenteroaxial
 rotation is more frequently seen in patients with
 progression of a type 2 paraesophageal hiatal hernia.

The most common cause of gastric volvulus in adults is diaphragmatic defects. In cases of paraesophageal hernias, the gastroesophageal junction remains in the abdomen while the stomach ascends adjacent to the esophagus, resulting in an upside-down stomach. Gastric volvulus is the most common complication of paraesophageal hernias. It has also been reported to complicate gastroesophageal surgery, neuromuscular disorders, and intra-abdominal tumors. Rarely, gastric volvulus may be a complication of liver transplant and may be related to ligation of the hepatogastric ligament during the hepatectomy.

Video Endoscopic Sequence 2 of 3.

 The most common cause of gastric volvulus in adults is
 diaphragmatic defects. In cases of paraesophageal hernias,
 the gastroesophageal junction remains in the abdomen
 while the stomach ascends adjacent to the esophagus,
 resulting in an upside-down stomach. Gastric volvulus is
 the most common complication of paraesophageal hernias.

 It has also been reported to complicate gastroesophageal
 surgery, neuromuscular disorders, and intra-abdominal
 tumors. Rarely, gastric volvulus may be a complication of
 liver transplant and may be related to ligation of the
 hepatogastric ligament during the hepatectomy.

 

Video Endoscopic Sequence 3 of 3.
Non-specific finding in the gastric fundus in a lupus patientīs This 54 year-old female with systemic lupus erythaematosus presenting with abdominal pain, physical Examination the abdomen soft, nontender, no masses, hernias or organomegaly, two months previously had discontinued her treatment with corticosteroids .

Video Endoscopic Sequence 1 of 7.

Non-specific finding in the gastric fundus in a lupus patientīs

 This 54 year-old female with systemic lupus
 erythaematosus presenting with abdominal pain, physical
 Examination the abdomen soft, nontender, no masses,
 hernias or organomegaly, two months previously had
 discontinued her treatment with corticosteroids.

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease of unknown cause that affects multiple organ systems. Immunologic abnormalities, especially the production of a number of antinuclear antibodies, are another prominent feature of this disease. The clinical course is marked by spontaneous remissions and relapses. Its multisystemic manifestations and the complications from the use of immunosuppressive agents make the diagnosis and management of this entity challenging.

Video Endoscopic Sequence 2 of 7.

 

 Systemic lupus erythematosus (SLE) is a chronic
 inflammatory disease of unknown cause that affects
 multiple organ systems. Immunologic abnormalities,
 especially the production of a number of antinuclear
 antibodies, are another prominent feature of this disease.
 The clinical course is marked by spontaneous remissions
 and relapses. Its multisystemic manifestations and the
 complications from the use of immunosuppressive agents
 make the diagnosis and management of this entity
 challenging.
Gastric Erosion is observed the biopsies were negative to malignancy. Gastrointestinal (GI) manifestations are common in patients with systemic lupus erythematosus (SLE). Virtually all patients with SLE require treatment with NSAID therapy and/or corticosteroids. The ulcerogenic effects of NSAIDs and corticosteroids used in combination are synergistic and put the patient at a high risk of serious ulcer disease. In addition, high-dose steroids may mask the early clinical signs of peptic ulcer perforation.

Video Endoscopic Sequence 3 of 7.

Gastric Erosion is observed the biopsies were negative to malignancy.

 Gastrointestinal (GI) manifestations are common in
 patients with systemic lupus erythematosus (SLE).
 Virtually all patients with SLE require treatment with
 NSAID therapy and/or corticosteroids

 The ulcerogenic effects of NSAIDs and corticosteroids
 used in combination are synergistic and put the patient at
 a high risk of serious ulcer disease. In addition, high-dose
 steroids may mask the early clinical signs of peptic ulcer
 perforation.

Impairment of blood supply to various parts of the gastrointestinal tract may result in abdominal pain, damage to the liver or pancreas (pancreatitis), or a blockage or tear (perforation) of the gastrointestinal tract.

Video Endoscopic Sequence 4 of 7.

 Systemic lupus erythematosus: Gastrointestinal Tract
 Problems: Impairment of blood supply to various parts of
 the gastrointestinal tract may result in abdominal pain,
 damage to the liver or pancreas (pancreatitis), or a
 blockage or tear (perforation) of the gastrointestinal tract.

 
The inflammatory infiltrate from patients with SLE was found to contain higher levels of young and mature fibroblasts than those from patients with gastroduodenitis, and was associated with the progression of SLE. During disease exacerbation, immune complex deposition was observed in the arteriolar walls.

Video Endoscopic Sequence 5 of 7.

 The inflammatory infiltrate from patients with SLE was
 found to contain higher levels of young and mature
 fibroblasts than those from patients with gastroduodenitis,
 and was associated with the progression of SLE. During
 disease exacerbation, immune complex deposition was
 observed in the arteriolar walls

 The inflammatory changes in the gastric and duodenal
 mucosa were ascertained to be associated with the
 progression of SLE. In exacerbation of SLE, the walls of
 vessels (arterioles) exhibited immune complexes classified
 mainly as IgG and, to a lesser degree, as IgM.
 In remission, the luminescence of the vessels decreased.
 The serum level of immunoglobins did not correlate with
 their regional production in the gastric and duodenal
 mucosa.
Systemic lupus erythematosus (SLE) on the gastrointestinal (GI) tract from mouth to anus, attempting to distinguish the features that are most likely to be due to therapy. GI manifestations of SLE include mouth ulcers, dysphagia, anorexia, nausea, vomiting, haemorrhage and abdominal pain. GI vasculitis is usually accompanied by evidence of active disease in other organs. Early recognition of the significance of these symptoms offers the best opportunity.

Video Endoscopic Sequence 6 of 7.

 Systemic lupus erythematosus (SLE) on the
 gastrointestinal (GI) tract from mouth to anus, attempting
 to distinguish the features that are most likely to be due to
 therapy. GI manifestations of SLE include mouth ulcers,
 dysphagia, anorexia, nausea, vomiting, hemorrhage and
 abdominal pain. GI vasculitis is usually accompanied by
 evidence of active disease in other organs. Early
 recognition of the significance of these symptoms offers
 the best opportunity.
The inflammatory infiltrate from patients with SLE was found to contain higher levels of young and mature fibroblasts than those from patients with gastroduodenitis, and was associated with the progression of SLE. During disease exacerbation, immune complex deposition was observed in the arteriolar wall.

Video Endoscopic Sequence 7 of 7.

 The inflammatory infiltrate from patients with SLE was
 found to contain higher levels of young and mature
 fibroblasts than those from patients with gastroduodenitis,
 and was associated with the progression of SLE. During
 disease exacerbation, immune complex deposition was
 observed in the arteriolar walls
Foreign body. Chewed gum in the stomach. Patient swallowed the gum while in the waiting room.

Foreign body.

 Chewed gum in the stomach.
 Patient swallowed the gum while in the waiting room.
 

Phytobezoar. Bezoars are concretions in the GI tract that increase in size by the accumulation of nonabsorbable food or fibers. They are uncommon, but when present, they are usually found in patients with altered GI motility or with a history of gastric surgery. A phytobezoar is composed of indigested plant or vegetable fibres, plant skins and leaves. A phytobezoar may develop when foreign material accumulates in the stomach because of indigestibility, poor mastication or disturbances in the gastric emptying mechanism which can occur following surgical procedures such as vagotomy, pyloroplasty or antrectomy. A trichobezoar is secondary to hair ingestion, usually in mentally disturbed patients.

Phytobezoar.

 Bezoars are concretions in the GI tract that increase in size
 by the accumulation of nonabsorbable food or fibers. They
 are uncommon, but when present, they are usually found in
 patients with altered GI motility or with a history of gastric
 surgery.
 A phytobezoar is composed of indigested plant or vegetable
 fibres, plant skins and leaves. A phytobezoar may develop
 when foreign material accumulates in the stomach because
 of indigestibility, poor mastication or disturbances in the
 gastric emptying mechanism which can occur following
 surgical procedures such as vagotomy, pyloroplasty or
 antrectomy. A trichobezoar is secondary to hair ingestion,
 usually in mentally disturbed patients