Pharmacobezoar-a rare case presented as gastric outlet obstruction

Tangled culprit: a rare case of bezoar-induced small bowel obstruction with pulmonary Edema in a rural Guatemalan woman

We present the unusual case of a 52-year-old woman from a low-resource community in Guatemala who developed small bowel obstruction, followed by acute pulmonary edema. The patient had no prior history of abdominal surgeries or significant comorbidities, making this presentation unexpected. The obstruction was caused by a bezoar and complicated by fluid overload during resuscitation. Radiologic findings revealed dilated bowel loops, suggesting bowel obstruction, and Kerley B lines, indicating concurrent pulmonary edema. This report underscores the challenges of managing complex emergencies in resource-limited settings, highlighting the importance of timely surgical intervention and careful fluid management.

Duodenal Phytobezoar Treated With Endoscopic Removal: A Case Report

Gastric outlet obstruction (GOO) is a blockage within the proximal gastrointestinal tract that most commonly occurs within the stomach. GOO can present with symptoms like nausea, vomiting, upper abdominal pain, early satiety, weight loss, or abdominal distention with a succussion splash. Diagnosis is most evident with an abdominal X-ray showing dilation proximal to the obstruction and air-fluid levels, but other visualization techniques like abdominal CT and upper endoscopy may be useful in the diagnosis depending on the underlying cause. This clinical condition has multiple causes, with malignancy being the most prominent; however, rare cases like gastrointestinal bezoars may occur in the setting of altered gastric motility. We present a case of a 47-year-old male with GOO caused by a phytobezoar, a mass of undigested vegetable material, in an uncommon location, the duodenum. Upon endoscopic removal of the bezoar, the patient had a resolution of symptoms, and he was instructed to modify his dietary habits, the underlying cause of the obstruction.

Gastric Bezoar: Cause of Weight Loss in a Patient With Previous Bariatric Surgery

Gastric bezoar is a concretion of undigested material found in the stomach and is classified by its composition. Patients may remain asymptomatic or present with a variety of gastrointestinal symptoms. Upper gastrointestinal endoscopy is required to establish the diagnosis. Treatment options include chemical dissolution, endoscopic removal, or surgical removal. Here, we present a rare case of gastric bezoar in a patient with a remote history of bariatric surgery presenting with acute weight loss.

Pharmacobezoar After Venlafaxine and Oxazepam Overdose: How Pharmacokinetics Could Help?-A Grand Round

ABSTRACT

The authors present here a case of a pharmacobezoar after drug overdose, diagnosed using multiple blood samples for TDM. This grand round highlights the importance of a dialog between a clinician and a TDM consultant for the optimal care of a patient.

Clinical and Forensic Aspects of Pharmacobezoars

BACKGROUND

Pharmacobezoars are specific types of bezoars formed when medicines, such as tablets, suspensions, and/or drug delivery systems, aggregate and may cause death by occluding airways with tenacious material or by eluting drugs resulting in toxic or lethal blood concentrations.

OBJECTIVE

This work aims to fully review the state-of-the-art regarding pathophysiology, diagnosis, treatment, and other relevant clinical and forensic features of pharmacobezoars.

RESULTS

Patients of a wide range of ages and of both sexes present with signs and symptoms of intoxications or more commonly gastrointestinal obstructions. The exact mechanisms of pharmacobezoar formation are unknown but are likely multifactorial. The diagnosis and treatment depend on the gastrointestinal segment affected and should be personalized to the medication and the underlying factor. A good and complete history, physical examination, image tests, upper endoscopy, and surgery through laparotomy of the lower tract are useful for diagnosis and treatment.

CONCLUSION

Pharmacobezoars are rarely seen in clinical and forensic practice. They are related to controlled or immediate-release formulations, liquid, or non-digestible substances, in normal or altered digestive motility/anatomy tract, and in overdoses or therapeutic doses, and should be suspected in the presence of risk factors or patients taking drugs which may form pharmacobezoars.

Upper Gastrointestinal Manifestation of Bezoars and the Etiological Factors: A Literature Review

A gastric bezoar is a compact mass of indigestible foreign materials that accumulate and consolidate in the stomach; however, it can be found in other sites of the gastrointestinal tract. The causative manner of this condition is complex and multifactorial. The main purpose of the review was to raise awareness among clinicians, particularly gastroenterologists, that patients with certain risk factors or comorbid conditions are predisposed to gastric bezoar formation. Early diagnosis and prompt intervention are crucial to avoid bezoar-induced complications. Upper gastrointestinal endoscopy is the standard diagnostic and therapeutic method for gastric bezoars. However, for large size bezoars, surgical intervention is needed.

Observation on the curative effect of long intestinal tube in the treatment of phytobezoar intestinal obstruction

The aim of the study was to observe the curative effect of long intestinal tube (LT) in the treatment of phytobezoar intestinal obstruction.We performed a retrospective study of patients with phytobezoar intestinal obstruction who underwent decompression with different tube insertion method. A total of 80 patients were collected and divided into nasogastric tube (NGT) group (n = 36) and LT group (n = 44) between August 2015 and August 2018 at our hospital. Univariate analysis was used to assess the clinical efficacy of 2 groups of patients.There were no significant differences in the mean age, sex ratio, and previous surgical history between the 2 groups. There were statistically significant differences between the 2 groups in terms of improvement time of clinical indications (4.2 ± 1.4 vs 2.5 ± 0.6 days; P = .008), liquid decompression amount on the first day of catheterization (870.4 ± 400.8 vs 1738.4 ± 460.2 mL; P = .000), transit operation rate (4/36 vs 0/44; P = .023), clinical cure rate (25/36 vs 40/44; P = .014), total treatment efficiency (32/36 vs 44/44; P = .023), and total hospitalization cost (3.25 ± 0.39 vs 2.07 ± 0.41 ¥ ten thousand; P = .000).The curative effect of LT in the treatment of phytobezoar intestinal obstruction is accurate and reliable, which can effectively improve the clinical symptoms of patients, comprehensively improve the non-surgical rate of intestinal obstruction treatment, reduce the total cost of hospitalization, and is worthy of promotion in clinical application.