MOJ
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Clinical Report Volume 13 Issue 1
An unusual case of coconut bezoar
Dr Alexandra Valencia,
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Dr Xavier Moyon, Dr Paola Loaiza
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Bariatric Surgeon, Falconí Clinic, Ecuador
Correspondence: Dr. Alexandra Valencia, Bariatric Surgeon, Falconí Clinic, Quito, Ecuador
Received: March 15, 2025 | Published: March 31, 2025
Citation: Valencia A, Moyon X, Loaiza P. An unusual case of coconut bezoar. MOJ Surg. 2025;13(1):24. DOI: 10.15406/mojs.2025.13.00287
Introduction
A bezoar is a rare but recognized cause of gastrointestinal obstruction, especially in post-bariatric surgery patients. Coconut bezoars, composed of undigested coconut fibers, are particularly uncommon and can pose a diagnostic and therapeutic challenge. The anatomical and physiological alterations following Roux-en-Y gastric bypass (RYGB) can predispose patients to bezoar formation due to changes in gastric motility, decreased gastric acid secretion, and altered digestión.1,2
Case report
A 45-year-old female patient with a history of RYGB one year prior presented with nausea, vomiting (48-hour evolution), abdominal pain, and a sensation of fullness. Given her surgical history, an upper gastrointestinal obstruction was suspected.
Endoscopic evaluation confirmed the presence of a coconut bezoar in the gastric pouch. Endoscopic treatment was performed, utilizing mechanical fragmentation with a basket and forceps to facilitate extraction. The procedure was successful, and the patient’s symptoms resolved without the need for surgical intervention. She was advised to avoid high-fiber, poorly digestible foods to prevent recurrence.
Discussion
Bezoars following bariatric surgery are rare but well-documented complications.3,4 RYGB patients are at increased risk due to reduced gastric capacity, altered gastric emptying, and changes in dietary habits. Coconut fibers, due to their high cellulose content and resistance to enzymatic digestion, can contribute to bezoar formation in susceptible patients.5
Diagnosis is best achieved through upper endoscopy, which provides both visualization and therapeutic options. Endoscopic removal is the preferred approach, offering a minimally invasive solution to bezoar-related obstruction.6 However, in cases of large or impacted bezoars, surgical intervention may be required.7
Conclusion
This case highlights the importance of considering bezoars in post-RYGB patients presenting with gastrointestinal obstruction symptoms. Bariatric endoscopy plays a crucial role in diagnosis and management, often preventing the need for more invasive surgical procedures. Furthermore, nutritional education and dietary modifications are essential preventive strategies to minimize the risk of bezoar formation in this patient population.
Acknowledgments
None.
Conflicts of interest
The authors declare that there are no conflicts of interest.
References
- Zhang R, Yang Z, Fan B. A rare case report of late-onset phytobezoar formation following laparoscopic sleeve gastrectomy. BMC Surgery. 2021;254.
- Norsa L, Valle C. Gastrointestinal phytobezoar following bariatric surgery: A review of the literature. Surgery for Obesity and Related Diseases. 2016;12(9):1747–1754.
- Iwamuro M, Okada H, Matsueda K, et al. Review of the diagnosis and management of gastrointestinal bezoars. World J Gastrointest Endosc. 2015;7(4):336–345.
- Oh SH, Namgung H, Park MH, e al. Bezoar-induced small bowel obstruction. J Korean Soc Coloproctol. 2012;28(2):89–93.
- University of Virginia Health System. Bezoars: Recognizing and managing these stubborn, sometimes dangerous masses. Gastroenterology Nutrition. 2021.
- Wang YG, Seitz U, Li ZL, et al. Endoscopic management of huge bezoars. Endoscopy. 1998;30(4):371–374.
- Gorter RR, Kneepkens CMF, Mattens ECJL, et al. Management of trichobezoar: Case report and literature review. Pediatr Surg Int. 2010;26(5):457–463.
©2025 Valencia, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.