Gastrointestinal bezoars: two distinct cases illustrating diagnostic and surgical challenges

Introduction and importance: Bezoars are rare conglomerates of indigestible material within the gastrointestinal tract. Their clinical presentation varies depending on location and composition. We report two contrasting cases: a massive gastric trichobezoar in an adolescent female and multiple gastrointestinal phytobezoars in an adult male, illustrating the diagnostic and therapeutic diversity of this entity. Case presentation: The first case involved a 16-year-old girl presenting with epigastric pain and alopecia; imaging revealed a 20 × 14 cm gastric trichobezoar, successfully extracted via gastrotomy. The second case concerned a 50-year-old man with sub-occlusive symptoms. CT showed multiple bezoars from stomach to rectum, the largest (15 cm) being gastric. Surgery through midline laparotomy allowed manual expression of intestinal bezoars and gastrotomy for gastric extraction, with uneventful recovery. Clinical discussion: These cases highlight two extremes of bezoar disease: trichobezoar linked to psychiatric and behavioral disorders in young females, and extensive gastrointestinal phytobezoars in adults without underlying pathology. CT imaging remains essential for diagnosis and surgical planning. Laparotomy ensures complete removal in large or multiple bezoars, while postoperative management must address recurrence risk. Conclusion: Bezoars, though rare, should be suspected in patients with unexplained obstructive or epigastric symptoms. Early imaging and appropriate surgical intervention are key to avoiding complications.