Opioid Overdose and Serotonin Syndrome due to Gastric Bezoar in a Woman with Autism and Pica Behaviour

We are presenting the case of a 38-year-old woman with nonverbal autism and intellectual disability, hospitalized in a neurobehavioural unit because of a pica behaviour for 3 years. During the hospitalization, the patient presented an episode of pain, agitation, restlessness, rhabdomyolysis, coma, tachycardia, hyperthermia, shivering, and diarrhoea. The main hypothesis raised was tramadol overdose because of the immediate antidote response to the injection of naloxone 0,4 mg/mL. Even if we did not exceed the recommended prescription dosage of tramadol, the presence of gastric bezoar slowed the absorption of the drug, and the consequence was an opioid overdose and serotonin syndrome.

Migration of a gastric bezoar to esophagus: A rare cause of acute dysphagia

Sudden onset of dysphagia due to a gastric bezoar migrating to the esophagus is a relatively rare condition. A 72-year-old male patient with known gastric bezoar presented with sudden difficulty swallowing following nausea and vomiting caused by adhesive ileus. Gastroscopic examination showed a bezoar and associated compression ulcers in the esophagus. The bezoar was pushed towards the stomach and extracted by successful endoscopic fragmentation.

Gastrointestinal bleeding due to giant gastric bezoar

Gastric bezoars occur in the stomach due to foreign body accumulation with an inability to pass through the pylorus. Major complications of bezoars include intestinal obstruction, gastric ulcer, gastric perforation, and bleeding. Many gastric bezoars can often be treated conservatively. Endoscopy has been commonly used in both the diagnosis and treatment of bezoars. We present a case that complained about abundant gastrointestinal bleeding as well as abdominal distension and was successfully treated with emergency gastric surgery after the failure of bleed control by endoscopic intervention due to giant gastric bezoar.

Removal of a Small Bowel Bezoar Causing Bowel Obstruction via Mechanical Compression after Metal Stent Placement

Small bowel obstructions (SBOs) that develop for various reasons often require prompt medical treatment. Migration of a gastric bezoar (indigestible foreign material that has accumulated in the stomach) is a rare cause of SBO. Treatment of a symptomatic SBO caused by a bezoar requires a multidisciplinary approach that considers the patient’s physical status and comorbidities and the bezoar volume, location, and pathology. Although surgery is the treatment of choice, endoscopic treatments such as fragmentation and retrieval may serve as alternatives. We present the first case of resolution of a large phytobezoar via mechanical compression after covered metal stent insertion, followed by stent retrieval, in a patient with a symptomatic SBO that persisted even after two sessions of push-endoscopic fragmentation.

Hair loss in an infant presenting with failure to thrive

An 11-month-old male child with a complex past medical history presented for admission due to failure to thrive. He had hair loss throughout his scalp, and his abdomen was distended. There was parental report of hair pulling and hair in his stool. An upper gastrointestinal (GI) radiograph with fluoroscopy was performed and showed a filling defect in the gastric lumen. On endoscopy, he was found to have a gastric bezoar consisting of hair, nail, and food material. The trichobezoar was removed, and he began to tolerate feeds and showed consistent weight gain. There were no recurrence of symptoms 8 months following removal. While inadequate caloric intake is a common reason for failure to thrive, mechanical obstruction from a trichobezoar as a cause is rare and to our knowledge has not been reported in a child this young.