Temporal changes in computed tomography findings of a persimmon bezoar: A case report

Abstract

Background: Gastric bezoars are masses of indigestible material that accumulate in the stomach, causing nausea, abdominal pain, and vomiting. Persimmon bezoars (diospyrobezoars), which comprise tannins and fibers from persimmons, are relatively rare but may cause significant gastric complications, including gastric outlet obstruction or ileus. Although computed tomography (CT) is a useful imaging tool, diagnosing bezoars can be challenging because their density is similar to that of food debris and gastric content.

Case summary: Here, we report the case of a 72-year-old woman with a persimmon bezoar that was diagnosed using serial CT imaging and confirmed by endoscopy. CT performed over several months revealed changes in the internal structure and density of the bezoar, suggesting progressive hardening. The patient had a history of a partial gastrectomy and excessive persimmon consumption, both of which are risk factors for bezoar formation. Endoscopic fragmentation of the bezoar successfully resolved symptoms.

Conclusion: Gastric bezoars, particularly persimmon bezoars, present diagnostic challenges because of their variable imaging characteristics. Serial CT can document temporal changes in bezoar density, potentially reflecting changes in hardness. Early diagnosis and endoscopic treatment are essential for effective management, particularly in patients with predisposing factors. This case underscores the importance of considering bezoars in the differential diagnosis of gastric masses, and highlights the value of CT for monitoring changes in bezoar characteristics over time.

Keywords: Case report; Computed tomography; Endoscopic treatment; Gastric bezoar; Persimmon bezoar; Temporal changes.

Figure 1

Endoscopic findings and treatment of persimmon bezoar. A: Esophagogastroduodenoscopy showing an elongated, black gastric bezoar approximately 10 cm in length; B: Infrared spectrometry of the bezoar fragments revealing a > 98% similarity to the spectra of persimmon extracts, confirming the diagnosis of persimmon bezoar; C: Endoscopic fragmentation of the bezoar using alligator forceps; D: Bezoar fragments after successful fragmentation. The procedure was completed in 2.5 hours.

Figure 2

Computed tomography imaging of persimmon bezoar over time. A: Computed tomography (CT) image obtained 12 months prior to presentation showing no visible abnormality in the stomach; B: CT image obtained nine months prior showing a spherical lesion (arrow) within the stomach, suggestive of a gastric bezoar; C: CT image obtained six months prior showing the bezoar's internal structure and density changes, with the lesion becoming more homogeneous (arrows).