Bezoar as a cause of intestinal obstruction as the first manifestation of duodenal adenocarcinoma

Abstract Background Gastric outlet obstruction (GOO) is a clinical syndrome characterized by abdominal pain and post-prandial vomiting due to a mechanical obstruction of the outlet of the stomach. Bezoars, concretions of undigested or partially digested material in the gastrointestinal tract, are a rare entity and GOO due to bezoar is an infrequent presentation. Case description We present the case of a 48-year-old female, attending the emergency room for abdominal pain and distension, nausea, vomiting and clinical signs of intestinal obstruction. Imaging studies showed an asymmetric thickening of the gastric antrum with dilation of the stomach at the expense of intraluminal mass. An oesophageal gastroduodenoscopy revealed the presence of non-suctionableable solid food content, antral mucosa thickened with necrotic ulcer of nodular aspect and a pyloric stenosis. The histopathological study showed a poorly differentiated adenocarcinoma in the muscle wall. Conclusions The development of a bezoar as a complication of duodenal carcinoma is a very rare entity. In the case discussed above, the main factor that is seen clinically and chronologically related to the development of our patient's bezoar is reduced antral motility and a partial obstruction of the outlet as a consequence of neoplastic involvement of the duodenum. Many patients remain asymptomatic for many years and develop symptomatology in an insidious manner, with vague symptoms including abdominal pain, nausea, vomiting, early satiety, anorexia, and weight loss. A detailed evaluation is necessary in order to exclude underlying disease, including malignancy, in patients who develop gastric bezoars.