John Mayo, MD, Robert Conrad, MD, Bridget Colgan, MD, William Harjes, MD, Robert Lim, MD. Tripler Army Medical Center
Background: Gastric bezoar is a rare but known complication following Roux-en-Y gastric bypass (RYGB). These bezoars are typically composed of indigestible plant matter and are usually associated with an underlying stricture. Lactobezoars, on the other hand, are composed of compacted milk proteins and gastric secretions that are reported in the literature to occur almost exclusively in neonates. We present the first case to our knowledge of a lactobezoar occurring after bariatric surgery, specifically without any underlying anastomotic stricture. This also appears to be the first case report of a lactobezoar occurring in an adult patient not taking high-density tube feedings and not critically ill.
Case Presentation: 49-year-old female three weeks status post RYGB for class III obesity presented with symptoms of gastric outlet obstruction after having added ricotta cheese several times daily to her post surgery diet of Greek yogurt and protein shakes. The patient underwent upper endoscopy and was found to have a lactobezoar that was successfully removed endoscopically. There was no underlying anastomotic stricture. The patient then tolerated a full liquid diet and was discharged later that same day.
Conclusion: Lactobezoar is a rare diagnosis in adults, reported to occur in those who are critically ill and on high-density gastric tube feedings. This report shows it can occur in the gastric pouch of a RYGB in patients who consume milk-based protein shakes and in this case ricotta cheese. The treatment is via endoscopy and dietary guidance with nutritionist consultation.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94692
Program Number: P066
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster