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Gastrolithiasis

Disease name

synonym Gastrolith (Stomach stone) generally refers to gastrolithiasis

This entry is made by Compilation and application of scientific encyclopedia entries of "Science Popularization China" authentication.

Du Shunda

(Deputy Chief Physician) Review

Basic Surgery Department of Peking Union Medical College Hospital

Due to ingestion of certain plant ingredients or ingestion of hair and certain minerals such as calcium carbonate Barium agent bismuth The foreign body formed by coagulation in the stomach is generally called gastrolithiasis. The patient may be completely asymptomatic, or have upper abdominal discomfort Anorexia 、 Halitosis , nausea, vomiting or varying degrees abdominal distention 、 abdominal pain Etc.

Foreign name: bezoar of the stomach
Alias: Stomach coprolite
Visiting department: Basic surgery
Multiple population: Patients with subtotal gastrectomy, vagotomy, gastroparesis syndrome

Common location: stomach
Common causes: Have the habit of swallowing hair, and feed with high concentration milk
common symptom: Upper abdomen pain, fullness, nausea, vomiting, hematemesis, etc
Chinese name: Gastrolithiasis

catalog

nine prevention

pathogeny

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1. Vegetative Stomachstone

It is mainly composed of various undigested plant ingredients, including Tannic acid , cellulose pectin , colloid, etc. Stomach persimmon stone is the most common plant stone 。

two Rubble

It is composed of hair, and can also be mixed with wool and animal hair. It is mostly seen in neurotic women who have the habit of swallowing hair, and it mostly occurs between 20 and 30 years old.

three lactic acid stone

It is mainly found in high concentration milk feeding Low birth weight newborn 。

clinical manifestation

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Gastrolithiasis is easy to occur in Subtotal gastrectomy 、 Vagus neurotomy 、 Gastroparesis syndrome Patients may have gastric motility Dysfunction of It can be divided into acute and chronic types. The course of disease is acute within 6 months, and chronic over 6 months, most of which are acute. The acute type is eating a lot of persimmons Hawthorn Symptoms appear after waiting for 1 to 2 hours, and more than half of the patients have Upper abdominal pain Swelling, nausea, vomiting, generally not much vomiting coffee Or blood, and a lot of haematemesis Rare. Because of the irritation and damage of gastric stone to local mucosa gastric ulcer 、 Erosion of gastric mucosa 、 Pyloric obstruction 、 intestinal obstruction , occasional perforation and peritonitis 。

About 30% of the cases were found in Epigastrium Accessible mobility Lump, generally without obvious tenderness.

inspect

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one laboratory examination

Some patients may present with small cell hypochromic anemia. Some patients Fecal occult blood test Positive, often seen at the initial stage Persimmon peel Sample. Gastric juice analysis Show Free gastric acid It is higher than that of normal people.

two Supplementary Examination

(1) X-ray examination X-ray barium meal fluoroscopy or air barium double contrast examination can find the shunting phenomenon of barium in the stomach, and show the free, lumpy, round or oval floating on the upper layer of barium Filling defect Area, and gastric mucosa Structural finishing, Gastric wall Soft. When the barium in the stomach is emptied, there are still bands, networks or sheets of barium spots adhering to the mass shadow. There is no obvious tenderness when pressing the shadow of the lump, and the contour shape and position can be changed with the strength, indicating that the lump has a certain degree Compressibility as well as Vagrancy 。

(2) Endofibroscopy The shape and character of intragastric stones can be observed directly under fiber endoscope.

(3) B-ultrasonic inspection B-ultrasound is helpful in the diagnosis of gastrolith. Patients are usually instructed to drink 500~1000ml of water, Seating or Semi recumbent position Through examination, we can see clearly defined Strong echo The mass image is floating on the water and can change its position with the change of body position or gastric peristalsis.

diagnosis

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The patient had a history of eating persimmon, hawthorn and black jujube, and soon after eating, he had stomach symptoms, including repeated epigastric pain, vomiting Black stool We should be alert to the possibility of gastrolith gastroscope And X-ray examination.

differential diagnosis

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Patients with chronic gastric persimmon stone often have chronic symptoms due to the long course of disease gastritis 、 ulcer or gastric cancer Similar, but through X-ray Barium radiography or Gastroscopy It is easy to differentiate from the above diseases.

complication

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Clinically common complication Superficial gastritis and gastric ulcer 。 If the patient merges gastritis 、 gastric ulcer 、 Gastric bleeding or Pyloric obstruction , there may be repetition abdominal pain Or hematemesis, vomiting and other corresponding clinical symptoms.

treatment

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one medication

For plant gastrolith, application sodium bicarbonate The treatment has a long history. It can be taken orally alone or in the same amount at the same time foaming agent Strengthen the curative effect and shorten the course of treatment. Some people advocate to add the above treatment Pepsin or Trypsin , also available Chymotrypsin （ Alpha Chymotrypsin ）Dissolve in water and take orally or from Gastric canal Medium injection, also added Acetylcysteine Soluble in normal saline , injected from gastric tube for 2-3 days. Metoclopramide can be used for patients with poor gastric motility（ Metoclopramide ）Domperidone or Sisapri To promote gastric peristalsis and facilitate stone removal. In addition, papain or cellulase (cellulase) Dissolve in water, and the effect can be seen even after taking it for 2 days.

2. Manual lithotripsy

For patients with gastrolith without obvious symptoms and complications, such as persimmon stone and hawthorn gastrolith, external abdominal massage can be tried to crush the stomach lumps into small pieces, and then gastric lavage or oral laxatives can be used to speed up the discharge of the lumps.

3. X-ray Offline Casing macadam method

In the early years, a net made of metal wires was inserted into the stomach tube, and when barium was used to show stomach stones, the net was used to cover and tighten the wires to cut stomach stones. Repeat the operation to make it cut into pieces and discharge naturally. On this basis, sodium bicarbonate and metoclopramide (metoclopramide) can also be added to promote the excretion of stones.

4. Fibroscope lithotripsy

Applied fiber Endoscopic therapy Gastrolith develops rapidly, and there are many joint methods. Can be used under the mirror Biopsy forceps Bite, clamp, tamp and puncture to destroy the gastrolith capsule or shell, and repeatedly flush with water; Endoscope can also be used Scalpel Repeatedly cut off the gastrolith capsule and the lump. Or use steel wire under fiber endoscope Snarer , cut the stone body, and then grab it into pieces with a pocket clamp to let it discharge naturally. In recent years, laser detonating lithotripsy under fiber endoscope has become an effective new way to treat gastrolith at home and abroad, especially for large and hard gastrolith. In addition, it can also be used for microwave lithotripsy under fiber endoscope, which is another simple method recently applied to treat gastric stones.

five Extracorporeal shock wave treatment

Development of extracorporeal shock wave from treatment of kidney stones to treatment gallstone , which has been tried for treatment in recent years Gastric calculus And succeed.

six Surgery surgical treatment

Stomach stone is large and hard Insoluble , medical treatment, endoscopic lithotripsy, microwave or shock wave treatment did not work, or the complications were serious gastric ulcer The patients with bleeding, perforation or obstruction should be treated by surgery.

prognosis

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Once the stomach stone is removed, there will be no further harm to the body.

prevention

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avoid Fasting Eat a lot Persimmon 、 Black jujube Get rid of the habit of chewing hair and actively treat Gastrointestinal dynamic disease To prevent the formation of stomach stones.

When eating persimmons and other fruits that are easy to cause stomach stones, it is not easy to drink too much water at the same time.

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