Endoscopic therapy for chestnut bezoar complicated by gastric ulcer and perforation

An 86-year-old man was admitted to our hospital with bronchial asthma. His medical history included chronic renal failure, carcinoma of the prostate, bronchial asthma and dementia. On the sixth day after admission, the patient suddenly complained of epigastric pain, and muscular defense was detected on physical examination. A chest X-ray and CT scan showed free air in the abdomen and gastric perforation was suspected. Considering the patient’s age and dementia, conservative therapy was elected. Contrast imaging using amidotrizoic acid identified a mass in the fornix which moved according to the patient’s body position. Endoscopic examination revealed a yellow-green colored mass in the fornix and an ulcer associated with perforation in the upper body of stomach. From these findings, a diagnosis of bezoar was made. Endoscopic removal of the bezoar was performed on the 37th day after admission. Chemical analysis of the bezoar revealed tannic acid. The patient reported frequent consumption of a large amount of chestnuts prior to admission.A bezoar is defined as an indigestible mass composed by hair and vegetable fibers along with other materials. Reported cases of bezoars in Japan comprise those originating from plant material；75% of these cases were from persimmons. Up until now, only 10 cases of bezoar complicated with gastric ulcer and perforation have been reported in the literature, with all cases treated surgically. Endoscopic therapy is one of the options for bezoars with gastric perforation.