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Resumen Los "bezoar" son conglomerados de materiales no comestibles ingeridos voluntaria o involuntariamente, no digeridos e incapaces de transitar por el tracto intestinal. Principalmente afectan a jóvenes mujeres o adolescentes que presentan el fenómeno llamado "pica", y a pesar de que se ha registrado una alta prevalencia de este fenómeno en pacientes con enfermedad renal crónica (ERC), ha sido poco estudiado. Caso clínico: Paciente del sexo masculino de 35 años de edad que cursa con ERC KDIGO-5 en tratamiento con diálisis peritoneal; se obtiene el hallazgo de "bezoar plástico" transoperatorio (laparotomia por oclusión intestinal) a 10 cm de la válvula ileocecal. El paciente fallece por complicaciones de la patología de origen. Se plantea la necesidad de realizar la búsqueda de comportamientos en pacientes con ERC, que indiquen al cirujano la sospecha, dado que los pacientes generalmente ocultan u omiten referir sobre la ingesta de material extraño.

Abstract The "bezoar" are conglomerates of inedible materials ingested voluntarily or involuntarily, which are not digested and are unable to pass through the intestinal tract. They mainly affect young women or adolescents who present the phenomenon called "pica", despite the fact that a high prevalence of this phenomenon of "pica" has been registered in patients with chronic kidney disease, it has been little studied. Clinical case: A 35-year-old male with CKD KDIGO-5 undergoing peritoneal dialysis treatment, which was found to have a transoperative "plastic bezoar" (laparotomy for intestinal occlusion) 10 cm from the ileocecal valve. The patient died due to complications of his pathology. Discussion: the clinical case raises the need to search for behaviors such as pica in patients with CKD, as well as to develop the suspicion to the surgeon, since patients generally hide or ignore reporting foreign material phagia.

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BACKGROUND: Rapunzel syndrome is the formation of a trichobezoar that extends beyond the small intestine. Since its discovery few cases have been reported in the literature with variable clinical characteristics, causing important complications such as intestinal obstruction. Laparotomy is currently considered the treatment of choice. CASE REPORT: We present the clinical case of a patient who presented with recurrent peritonitis associated with a peritoneal dialysis catheter, anorexia, nausea, vomiting, without channeling or presenting evacuations, epigastric tumor, anxiety, trichotillomania and trichophagia. Rapunzel syndrome is diagnosed and admission to the operating room is decided.

ANTECEDENTES: El síndrome de Rapunzel es la formación de un tricobezoar que se extiende más allá del intestino delgado. Desde su descubrimiento, pocos casos se han reportado en la literatura y con características clínicas variables, provocando complicaciones importantes como obstrucción intestinal. Actualmente, la laparotomía se considera el tratamiento de elección. CASO CLÍNICO: Paciente de sexo femenino que acude por presentar peritonitis de repetición asociada a catéter de diálisis peritoneal, anorexia, náuseas, vómito, sin canalizar ni presentar evacuaciones, tumoración en epigastrio, ansiedad, tricotilomanía y tricofagia. Se realiza el diagnóstico de síndrome de Rapunzel y se decide su ingreso a quirófano.

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Los bezoares gastrointestinales son agregados no digeribles que fueron previamente ingeridos, el tricobezoar se sitúa dentro de la clasificación de éstos, su composición es de cabellos y restos alimentarios, tiene como ubicación más frecuente al estómago y rara vez se extiende hacia duodeno, yeyuno, íleon e incluso colon, condición entonces denominada síndrome de Rapunzel. Es una entidad rara, con incidencias que van desde 0.068% - 0.43%. Los pacientes a menudo muestran sintomatología digestiva inespecífica, como: dolor abdominal difuso, náuseas, vómitos, pobre ganancia de peso, ictericia obstructiva, enteropatía por pérdida de proteínas, masa abdominal y suele asociar además síntomas psiquiátricos . Se presenta el caso de una paciente de 7 años con hemorragia digestiva alta como debut de enfermedad, secundario a tricobezoar.

Gastrointestinal bezoars are indigestible aggregates that were previously ingested, the trichobezoar were placed within the disposition classification, its composition is hair and food remain, its most frequent location is the stomach and rarely extends to the duodenum, jejunum, ileum and even the colon, a condition then called Rapunzel syndrome. It is a rare entity, with incidences ranging from 0.068% - 0.43%. Patients often show digestive symptoms, such as: unexpected diffuse abdominal pain, nausea, vomiting, poor weight gain, obstructive jaundice, protein-loss enteropathy, abdominal mass, and often also associate psychiatric symptoms. We present the case of a 7-year-old patient with upper gastrointestinal bleeding as a disease debut, secondary to trichobezoar.

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RESUMEN Se realizó un reporte de un caso de paciente femenina de 48 años de edad, con antecedentes patológicos personales de hipertensión arterial, cardiopatía isquémica, arritmias cardíacas y neurosis depresiva e ingestión diaria de cuerpos extraños desde hace algunos años, la cual tenía el hábito de masticar fragmentos de espuma de poliestireno (poliespuma), los que diluía en gasolina para poderlos moldear, ablandar e ingerirlos posteriormente. La paciente acudió a la consulta de Gastroenterología por presentar epigastralgia, acidez, sensación de repletes gástrica posprandial, aun cuando solo podía digerir escasas cantidades de alimento. Se realizó endoscopia, donde se apreció a la entrada de la luz gástrica un bezoar gigante de consistencia dura, superficie lisa, no movible, que midió aproximadamente 6-7 cm de diámetro, que ocupó prácticamente el 50 % de la luz gástrica, correspondiente al fundus y cuerpo gástrico, con extensión hacia el antro. Los intentos de extraerlo por vía endoscópica fueron fallidos, por lo que se intervino quirúrgicamente y se extrajo el mismo. La paciente tuvo una evolución posoperatoria favorable y egresó a los siete días, con seguimiento por consulta externa y tratamiento médico ambulatorio.

ABSTRACT A 48-year-old female presented to gastroenterologist consultation with epigastralgia, heartburn, and sensation of postprandial gastric fullness even when she only could intake meal in small proportion. She had a history of hypertension, ischemic heart disease, and cardiac arrhythmias, depressive neurosis associated to the ingestion, daily and since several years, of foreign bodies. She was used to chewing fragments of polyfoam, which she diluted them in gasoline in order to mold them, soften them and ingests them afterwards. An endoscopy procedure was used, which revealed, at the entrance of the gastric lumen, a giant bezoar of hard mass, smooth surface, non-movable, with approximately 6-7 cm size and occupying almost 50% of the gastric lumen region corresponding to the gastric body and fundus, and extending to the antrum. Attemps for removal the mass, endoscopically, were unsuccessful, so surgery was performed and it was removed successfully. The patient had a favorable postoperative evolution and was discharged 7 days after surgery, with outpatient follow-up and ambulatory medical treatment.

RESUMO Relatou-se o caso de uma paciente do sexo feminino, 48 anos, com história patológica pessoal de hipertensão arterial, cardiopatia isquêmica, arritmias cardíacas e neurose depressiva e ingestão diária de corpos estranhos há alguns anos, que tinha hábito de mastigar fragmentos de espuma de poliestireno (polyfoam), que ele diluiu em gasolina para poder moldar, amolecer e ingerir depois. A paciente compareceu à consulta de Gastroenterologia por apresentar epigastralgia, azia, sensação de plenitude gástrica pós-prandial, embora só conseguisse digerir pequenas quantidades de alimentos. Foi realizada endoscopia, onde um bezoar gigante de consistência dura, superfície lisa, imóvel, medindo aproximadamente 6-7 cm de diâmetro, ocupando praticamente 50% da luz gástrica, correspondente à luz gástrica, foi observado na entrada do lúmen gástrico, fundo e corpo gástrico, com extensão em direção ao antro. As tentativas de removê-lo endoscopicamente não tiveram sucesso, então ele foi submetido a uma cirurgia e foi removido. O paciente teve evolução pós-operatória favorável, com alta hospitalar sete dias após, com acompanhamento ambulatorial e acompanhamento médico ambulatorial.

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PURPOSE: To draw the attention of the medical community to a differential diagnosis of intestinal obstruction due to bezoar in the late postoperative period of gastric bypass that requires diagnosis and emergency management. METHODS: We report 8 cases of patients with intestinal obstruction due to bezoar in the late postoperative period of gastric bypass who required surgical intervention. CONCLUSION: Intestinal obstruction due to fruit pomace is a late complication that may require urgent surgical intervention and should be considered in the differential diagnosis.

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Ingestion of indigestible foreign bodies in both domestic and wild ruminants are very common. Indigestible foreign materials can be ingested during free range grazing or under captivity in zoos or game parks. There are different types of bezoars in literature. The most common in animals are phytobezoars, trichobezoars, lactobezoars, phytotrichobezoars, lithobezoars or pharmacobezoars. This is a case study of an adult (4 years old), 40 kg body weight female Fallow Deer (Dama dama) which was reared with other four more Fallow Deer does at Riyadh Zoological Garden. The doe was found sluggish and weak. On presentation the veterinarian of the zoo noticed the anorexia, pale mucous membranes and dullness. There was Normocytic Normochromic anaemia, low RBCs and Haematocrit level, high neutrophil count and leucocytosis. The doe was subjected to medicinal and supportive therapy but she could not recover and found dead on very next day. On post-mortem examination, an unusual large polythene bezoar along with calcified stony mass recovered from the rumen. The results suggested that the rumen impaction in the Fallow Deer might be due scavenging on refused Plastic dumps in the premises left over by visitors to the zoo and that the blood biochemical alterations, alongside clinical signs, might be of some diagnostic assistance.

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Ingestion of indigestible foreign bodies in both domestic and wild ruminants are very common. Indigestible foreign materials can be ingested during free range grazing or under captivity in zoos or game parks. There are different types of bezoars in literature. The most common in animals are phytobezoars, trichobezoars, lactobezoars, phytotrichobezoars, lithobezoars or pharmacobezoars. This is a case study of an adult (4 years old), 40 kg body weight female Fallow Deer (Dama dama) which was reared with other four more Fallow Deer does at Riyadh Zoological Garden. The doe was found sluggish and weak. On presentation the veterinarian of the zoo noticed the anorexia, pale mucous membranes and dullness. There was Normocytic Normochromic anaemia, low RBCs and Haematocrit level, high neutrophil count and leucocytosis. The doe was subjected to medicinal and supportive therapy but she could not recover and found dead on very next day. On post-mortem examination, an unusual large polythene bezoar along with calcified stony mass recovered from the rumen. The results suggested that the rumen impaction in the Fallow Deer might be due scavenging on refused Plastic dumps in the premises left over by visitors to the zoo and that the blood biochemical alterations, alongside clinical signs, might be of some diagnostic assistance.(AU)

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We presented a case of a 64-year-old female patient with a history of gastric bypass that presented with bowel obstruction due to a bezoar. She arrived at the emergency department, referring to severe abdominal pain, nausea, and vomiting. Abdominal X-ray reported gastric distention and hydro-air levels. CT scan reported swirling of the mesentery vessels and a collapsed intestinal loop, mimicking an internal hernia. Laparotomy was accomplished, which shows obstruction at 60 cm from the ileocecal valve. An enterolithotomy was performed, and a 6 × 6 cm phytobezoar was extracted. The patient had a satisfactory postoperative outcome, discharging her home on the fourth postoperative day. On a 12 month-follow up, the patient is doing well with no further complications. Gastric bypass continues to be one of the most performed bariatric procedures with low complication rates. It is important to note that not all intestinal obstructions in postoperative bariatric surgeries are due to internal hernias or adhesions. The differential diagnosis of intestinal obstruction due to bezoar must be present in patients who underwent bariatric surgery. Nutritional counseling is essential for the follow-up of patients, emphasizing fluid intake and slow chewing, as well as the use of absorbable materials for suture during the surgery.

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Resumen Se presenta el caso de una paciente de 35 años, quien ingresa al servicio de urgencias de un hospital de tercer nivel, por causa de un cuadro de 6 meses de saciedad precoz, pérdida de peso y, en el momento del examen físico de ingreso, se observan signos de desnutrición. En consecuencia, se realiza una endoscopia de las vías digestivas altas en las que se descubre un tricobezoar que ocupa toda la cámara gástrica y se extiende más allá de la tercera porción del duodeno. Mediante una tomografía axial computarizada (TAC) de abdomen, se confirma la presencia de una lesión que ocupa la cámara gástrica y el duodeno, por lo que la paciente es conducida a cirugía. Allí se encuentra el tricobezoar que confirma el diagnóstico de síndrome de Rapunzel. Luego de la cirugía, la paciente presenta una adecuada evolución posoperatoria, con resolución de los síntomas de ingreso. Asimismo, se inicia una intervención por nutrición y psicología, a fin de manejar la desnutrición y el trastorno psiquiátrico de base.

Abstract A 35-year-old patient was admitted to the emergency department of a third-level hospital following six months of early satiety and weight loss. Upon physical admission, the patient had signs of malnutrition. Upper digestive tract endoscopy found a trichobezoar that occupied the entire gastric chamber and extended into the third portion of the duodenum. This diagnosis was confirmed by an abdominal CT scan. Surgery confirmed the diagnosis of Rapunzel Syndrome. Following surgery the patient's evolution was good and symptoms resolved. Nutritional and psychological interventions were initiated to manage malnutrition and an underlying psychiatric disorder.

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Introducción. La miniderivación (mini-bypass) gástrica por laparoscopia es un procedimiento bariátrico que recientemente ha cobrado popularidad. Las alteraciones del tubo digestivo generadas por estos procedimientos pueden ocasionar diversas complicaciones, algunas raras, como los bezoares.Caso clínico. Se presenta el caso de una mujer de 52 años de edad con antecedentes de diabetes mellitus y obesidad, que fue tratada con una miniderivación gástrica por laparoscopia. Nueve meses después del procedimiento, presentó dolor en el epigastrio, intolerancia a los alimentos y vómito, por lo cual se dio tratamiento sintomático sin obtener mejoría. Se practicó una endoscopia de vías digestivas altas, cuyo hallazgo fue un bezoar de coco que obstruía parcialmente la anastomosis. El bezoar se trituró y se extrajo por endoscopia. Discusión. Los pacientes con antecedentes de cirugía bariátrica tienen mayor riesgo de presentar bezoares por la modificación del tubo digestivo. Estos pacientes presentan frecuentemente síntomas de dispepsia, por lo que la sintomatología inespecífica puede confundirse o subestimarse. Se debe considerar practicar una endoscopia en todos aquellos con antecedentes de cirugía bariátrica que presenten vómito persistente después de ingerir alimentos o síntomas de obstrucción gástrica

Introduction: Laparoscopic Mini-gastric bypass is a bariatric procedure that has gained popularity recently. Alterations to the gastrointestinal tract anatomy created during these procedures, may lead to several complications, some of them very rare, such as the bezoar. Presentation of case: A fifty-two years old female with type II diabetes mellitus and obesity was treated by laparoscopic mini-gastric bypass surgery. Nine months after her surgery she experienced epigastric pain, intolerance to food and vomiting with non-successful symptomatic treatment. One month later, the patient underwent an upper GI endoscopy which reported a coconut bezoar partially obstructing the anastomosis. Bezoar was broken into pieces and removed endoscopically. Two days after, patient returned to normal diet. Conclusion: Patients with bariatric surgeries have a higher risk of presenting such masses because of the gas-trointestinal tract modifications. Symptoms can be confused or overlooked in bariatric patients since there is a frequent complain of dyspeptic symptoms after such procedures. An endoscopy should be considered in every patient who underwent a bariatric procedure and presents with persistent vomiting after food ingestion and/or gastric outlet symptoms

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Los tricobezoares pertenecen a la clasificación de los bezoares, tumores abdominales formados por el acumulo de diversas sustancias que pueden ocasionar la oclusión intestinal, se presenta un paciente, femenina, que acuda al médico por presentar dolor abdominal y vómitos, en el examen físico abdominal se palpa una masa de aproximadamente 5 cm en el epigastrio que aparece y desaparece con los movimientos intestinales, se plantea inicialmente la posibilidad de padecer de una neoplasia abdominal, se realiza una endoscopia en donde informe que, en el fondo gástrico, cuerpo y antro está ocupado por cabello y restos alimenticios mal digeridos, la cual es removida mediante una laparotomía sobre el área que ocupaba la tumoración en el intestino delgado extrayendo un tricobezoar de 35 cm de longitud por 10 de ancho(AU)

The trichobezoars belong to the classification of bezoars, abdominal tumors formed by the accumulation of various substances that can cause intestinal occlusion, a patient, female, who comes to the doctor due to abdominal pain and vomiting, in the abdominal physical examination is presented palpa a mass of approximately 5 cm in the epigastrium that appears and disappears with bowel movements, initially poses the possibility of suffering from an abdominal neoplasm, an endoscopy is performed where it reports that, in the gastric fundus, body and antrum is occupied by hair and badly digested food remains, which is removed by a laparotomy on the area occupied by the tumor in the small intestine, extracting a trichobezoar measuring 35 cm long by 10 cm wide(AU)

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O objetivo deste artigo é um relatar um caso de paciente psiquiátrico atendido no Hospital Universitário Sul Fluminense (HUSF), no município de Vassouras/RJ, com quadro recidivante de bezoar metálico no trato gastrointestinal. Bezoares são corpos estranhos que podem obstruir o lúmen do aparelho digestivo a partir da ingestão continuada, prolongada e intencional de materiais não comestíveis ou de medicamentos de uso contínuo. Os bezoares podem apresentar extensão em continuidade para o intestino delgado ou fragmentação com múltiplas massas detectáveis em qualquer segmento intestinal. Neste caso foram realizadas laparotomias exploradoras para retirada dos corpos metálicos em região gástrica. Houve evasão do paciente do HUSF, o que impediu o acompanhamento do caso por equipe multidisciplinar (AU)

The purpose of this article is to describe a clinical case of relapsing metallic bezoar in the gastroinstestinal tract, observed in a psychiatric patient treated at the Hospital Universitario Sul Fluminense, located at city of Vassouras/ RJ. Bezoars are foreign bodies that impact the lumen of the digestive tract and are formed by the continued, prolonged and intentional ingestion of exotic materials or continuous use of medications. The bezoars may extend in continuity to the small intestine or could be presented as multiple masses detectable in any gut segment. By exploratory laparotomies, the metallic bodies in the gastric and intestinal region were removed. The patient evaded the Hospital and monitoring of the case by a multidisciplinary team was not possible. (AU)

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Los bezoares son recolecciones de material orgánico no digerible, que luego de ser ingerido, se acumulan con el tiempo en el estómago o intestino delgado. La presentación más común del bezoar es en la forma de fitobezoar, el cual es causado por la acumulación de partículas sin digerir de origen vegetal. Los fitobezoares son responsables de sólo 0,4-4 por ciento de todas las obstrucciones intestinales. Se presenta un paciente masculino de 51 años hospitalizado e intervenido quirúrgicamente por presentar una oclusión intestinal que en el acto operatorio se constató que la causa fue por fitobezoar. La presentación como oclusión intestinal es muy rara, dado que sigue un curso insidioso y progresivo. El diagnóstico de oclusión intestinal por bezoar puede resultar muy difícil, ya que es una entidad muy poco frecuente y la historia de la ingesta de estos materiales es rara vez expresada espontáneamente. El diagnóstico de oclusión intestinal secundaria a fitobezoar requiere de tratamiento quirúrgico precoz, ya que su retraso conlleva a una elevada morbimortalidad. El fitobezoar es una causa rara de obstrucción de intestino delgado. Su sospecha clínica es frecuentemente pasada por alto. Es importante conocer la conducta a seguir en estos casos para garantizar un correcto tratamiento(AU)

Bezoars are collections of indigestible organic material, which accumulate in the stomach or small intestine after being ingested. The most common presentation of bezoar is in the form of phytobezoar, which is caused by the accumulation of undigested particles of vegetable origin. Phytobezoars are responsible for 0.4-4 percent of all intestinal obstructions. A 51-year-old male patient was hospitalized and operated, after presentation with an intestinal occlusion. During the surgical procedure, the cause was found to be fitobezoar. This type of intestinal obstruction is much rare; it follows an insidious and progressive course. Its diagnosis can be much difficult; history of disagreement regarding these materials is rarely expressed by patients spontaneously. The diagnosis of intestinal secondary occlusion by phytobezoar requires early surgical treatment because the delay has led to high morbidity and mortality. The phytobezoar is a rare cause of small bowel obstruction. Ii is often ruled out as clinical suspicion. It is important to know how to perform in these cases, in order to ensure proper treatment(AU)

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La Pica es un síndrome caracterizado por la ingestión persistente de más de un mes de sustancias no nutritivas, se presenta en pacientes con alteración de la salud mental de cualquier causa con padecimientos de orden metabólico, enfermedad celíaca, drepanocitosis, déficit de nutrientes y embarazadas, entre otros. Las complicaciones asociadas a la Pica varían según el tipo de sustancia consumida, manifestándose como obstrucción intestinal -siendo esta la más frecuente- infecciones y desnutrición. Asimismo, observamos que el 75% de los pacientes atendidos necesita cirugía, el 30% sufre complicaciones y hasta el 11% fallece a consecuencia de la Pica o complicaciones postoperatorias. Por ser un síndrome de etiología no bien clarificada, multifactorial y recidivante, los pacientes debe ser evaluados y tratados por un equipo de salud multidisciplinario. En el presente estudio se presentan tres casos de pacientes pediátricos autóctonos de la provincia de Corrientes y una breve revisión y actualización clínica del tema.

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El tricobezoar es una masa de cabello no digerido que se encuentra en las vías gastrointestinal. Se alojan frecuentemente en el estómago pero se pueden ubicar a todo lo largo del tracto gastrointestinal. Se observan en sexo femenino en el 90% de los casos, y con una mayor frecuencia entre los 10 y 19 años. Se presenta el caso de una adolescente femenina de 11 años de edad quien cursa con enfermedad actual de 1 mes de evolución caracterizada por dolor abdominal, vómitos alimenticios pospandriales y pérdida de peso. Al examen se palpa una masa que ocupa el hemiabdomen superior. Se realiza tomografía computarizada de abdomen donde se evidencia imagen hipodensa y heterogénea que ocupaba la totalidad del estómago, compatible con cuerpo extraño. Se realiza laparotomía exploradora donde se evidencia tricobezoar gástrico.

Trichobezoar is a mass of undigested hair found within the gastrointestinal tract. They are often found in the stomach but may be found along the entire gastrointestinal tract. 90% of the cases occur in females between the age of 10 and 19 years. We present the case of an 11 years old girl who suffered abdominal pain, vomiting and weight loss for a month, with a palpable mass located in the upper abdomen quadrant. Abdomen computed tomography reported a hypodense heterogeneous image which occupied the whole of the stomach, compatible with foreign body. At laparotomy a gastric tricobezoar was found.

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O trato gastrointestinal das aves apresenta anatomia e fisiologia únicas. O inglúvio, ou papo, é uma distensão do esôfago com função de armazenar alimentos. Lesões e massas nesses locais podem ocorrer por diversos motivos, provocando dificuldades alimentares e emagrecimento da ave. O alimento ou material estranho impactado no interior de trato gastrintestinal pode formar os bezoares. Assim, objetivou-se descrever a ocorrência de massas em inglúvio de um periquito australiano atendido no Hospital Veterinário da Universidade Federal de Uberlândia, e identificadas como fitobezoar ou ingluvolitos após exame necroscópico e avaliação das massas encontradas.

The gastrointestinal tract of birds presents unique anatomy and physiology. The crop or chat, is a distension of the esophagus with function of storing food. Injuries and masses in these locations can occur for various reasons causing feeding difficulties and thinning of the bird. Food or foreign body impacted inside tract gatrintestinal can form the bezoars. Thus, the objective was reporting the occurrence of masses in crop in a budgerigar attended at the Veterinary Hospital of the Universidade Federal de Uberlândia, and diagnosed as phytobezoar or ingluvoliths after necropsy examination and evaluation of the mass found.

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The gastrointestinal tract of birds presents unique anatomy and physiology. The crop or chat, is a distension of the esophagus with function of storing food. Injuries and masses in these locations can occur for various reasons causing feeding difficulties and thinning of the bird. Food or foreign body impacted inside tract gatrintestinal can form the bezoars. Thus, the objective was reporting the occurrence of masses in crop in a budgerigar attended at the Veterinary Hospital of the Universidade Federal de Uberlândia, and diagnosed as phytobezoar or ingluvoliths after necropsy examination and evaluation of the mass found(AU)

O trato gastrointestinal das aves apresenta anatomia e fisiologia únicas. O inglúvio, ou papo, é uma distensão do esôfago com função de armazenar alimentos. Lesões e massas nesses locais podem ocorrer por diversos motivos, provocando dificuldades alimentares e emagrecimento da ave. O alimento ou material estranho impactado no interior de trato gastrintestinal pode formar os bezoares. Assim, objetivou-se descrever a ocorrência de massas em inglúvio de um periquito australiano atendido no Hospital Veterinário da Universidade Federal de Uberlândia, e identificadas como fitobezoar ou ingluvolitos após exame necroscópico e avaliação das massas encontradas(AU)

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Bezoars are accumulations of human or plant fiber located in the gastrointestinal tract of both humans and animals. Patients remain asymptomatic for several years, and the symptoms develop as these accumulations increase in size to the point of obstruction or perforation. We report the case of a 21-year-old patient at 10 d postpartum, who presented with acute abdomen associated with sepsis. Given the urgency of the clinical picture, at no point was the presence of a giant bezoar at gastric level suspected, specifically a trichobezoar. The emergency abdominal and pelvic ultrasound revealed only unspecific signs of perforated hollow viscus. Diagnosis was therefore made intraoperatively. A complete gastric trichobezoar was found with gastric perforation and secondary peritonitis. The peritoneal fluid culture revealed Candida glabrata.

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Objetivo: relatar um caso de metalobezoar intestinal. Relato de caso: paciente de 18 anos atendido no Serviço de Cirurgia Geral do Hospital de Emergências de Macapá-AP, com quadro de dor abdominal, vômitos e febre. Radiografia simples de abdome apresentando imagem radiopaca em quadrante inferior direito. Considerações Finais: confirmado diagnóstico de metalobezoar após abordagem cirúrgica por laparotomia exploratória, salientando a necessidade de, diante de um abdome agudo inflamatório, sempre ter em mente as causas comuns de sua ocorrência, mas também orientar a propedêutica e o diagnóstico diferencial para causas incomuns.

Objective: to report a case of intestinal metalobezoar. Case report: 18 year old patient attended at the General Surgery Service of the Emergency Hospital in Macapa-AP, with abdominal pain, vomiting and fever. Plain abdominal radiograph showing radiopaque image in the lower right quadrant. Final considerations: Confirmed diagnosis of metalobezoar after surgical exploratory laparotomy approach, stressing the need for, in a case of inflammatory acute abdomen, to always keep in mind the common causes of their occurrence, but also guide the propaedeutics and differential diagnosis for unusual causes.

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Los bezoares representan el 1% de las patologías abdominales. Existen hasta cinco tipos dependiendo de la causa que lo provoca. Existe tras la ingesta de alimentos que no son absorbibles a la mucosa intestinal. El tricobezoar es una variante que se caracteriza por la ingesta de cabello, uñas y pelos de las cejas. Es frecuentemente encontrado en mujeres jóvenes con alteraciones psicológicas asociadas. Normalmente cursan con molestias abdominales y es probable palpar una masa en el examen. El tratamiento definitivo depende de la naturaleza del tricobezoar, su tamaño y su consistencia.