Clinical and Forensic Aspects of Pharmacobezoars

Basílio, Francisco; Dinis-Oliveira, Ricardo Jorge

doi:10.2174/2589977512666200217094018

Cited by 6 publications

(4 citation statements)

References 105 publications

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“…The aggregation of pharmaceutical items, such as tablets, suspensions, or drug delivery devices, within the gastrointestinal tract causes the formation of a pharmacobezoar 20 . A growing list of medications has been implicated in pharmacobezoar formation; predisposing factors and pathogenic mechanisms have been recently reviewed by Basílio and Dinis-Oliveira 21 . At least 14 fatal cases of pharmacobezoars have been reported, involving 9 medication types 16,22 .…”

Section: Discussionmentioning

confidence: 99%

“…20 A growing list of medications has been implicated in pharmacobezoar formation; predisposing factors and pathogenic mechanisms have been recently reviewed by Basílio and Dinis-Oliveira. 21 At least 14 fatal cases of pharmacobezoars have been reported, involving 9 medication types. 16,22 The majority of deaths followed intentional overdose; however, accidental deaths have also occurred.…”

Section: Discussionmentioning

confidence: 99%

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Fatal Rapunzel Syndrome

Żyła

Jacques

2023

Am J Forensic Med Pathol

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We report a rare case of a young child, younger than10 years, who died of complications related to trichophagia and multiple gastrointestinal trichobezoars. One year before death, the child's clinical history yielded a diagnosis of iron deficiency anemia, believed to be related to poor diet, and alopecia areata, the etiology of which was unknown. Two weeks before death, the child presented with complaints of intermittent “flu-like” symptoms and vomiting. The child reported abdominal pain, anorexia, and fatigue on the night before death. The next morning, the child ate breakfast and was subsequently discovered unresponsive. On external examination, there were areas of thinning head hair. Postmortem computed tomography, magnetic resonance imaging, and internal examination revealed 3 distinct trichobezoars, occupying the stomach, jejunum, and ileum. This was complicated by small bowel obstructions and perforations due to the trichobezoars. The cause of death was peritonitis secondary to small bowel perforations due to small bowel obstruction with multiple trichobezoars. This is the first case report to demonstrate the utility of postmortem computed tomography and magnetic resonance imaging in characterizing the nature and extent of trichobezoars in a fatal case of Rapunzel syndrome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Fatal Rapunzel Syndrome

Żyła

Jacques

2023

Am J Forensic Med Pathol

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“…According to Basilio et al, 24 the exact reasons for the pharmacobezoars' formation remain unclear. Many factors may be involved including gastric motility, previous gastric surgery, medication properties, etc.…”

Section: Discussionmentioning

confidence: 99%

Pharmacobezoar-Related Fatalities: A Case Report and a Review of the Literature

Drevin,

Malbranque,

Jousset

et al. 2023

Therapeutic Drug Monitoring

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Pharmacobezoars develop after an acute overdose or during routine drug administration. Here, the authors present a case of fatal multidrug overdose involving a 62-year-old woman. Her usual treatment included tramadol extended-release, citalopram, and mirtazapine. Furthermore, she self-medicated and misused her husband's medications. The autopsy revealed the presence of a voluminous medication bezoar in the stomach. No mechanical complication was noted. Toxicologic analyses were performed using gas chromatography with flame ionization detection, liquid chromatography with diode array detection, gas chromatography with mass spectrometry detection, and liquid chromatography coupled to tandem mass spectrometry. Tramadol (34,000 mcg/L), O-desmethyltramadol (2200 mcg/L), propranolol (6000 mcg/L), bromazepam (2500 mcg/L), zopiclone (1200 mcg/L), and citalopram (700 mcg/L) were identified in femoral blood at toxic concentrations. Interestingly, the femoral blood and vitreous humor concentration ratio was approximately 0.7. Furthermore, an English exhaustive literature search was performed using several different electronic databases without any limiting period to identify published pharmacobezoar-related fatalities. Seventeen publications were identified reporting a total of 19 cases. Decedents' mean age was 47.6 years [0.8–79] and a clear female predominance emerged. Several drugs were involved in pharmacobezoar formation. Death was attributed to drug toxicity in 13 cases, and to mechanical complications and/or sepsis in 4 cases. A mixed cause of death was reported in 2 cases. Although rare, pharmacobezoars remain potentially lethal and raise challenges in therapeutic management.

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“…Pharmacobezoars are a unique class of bezoars that occur when medications aggregate. 1 They are well-described with many medications including aspirin and iron. Multivitamin bezoars represent a rare phenomenon.…”

Section: Case Reportmentioning

confidence: 99%

Pharmacobezoar Masquerading as a Colon Lesion: A Sticky Situation

Gunnarsson,

Canakis,

Goldberg

2024

ACG Case Rep J

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Clinical and Forensic Aspects of Pharmacobezoars

Cited by 6 publications

References 105 publications

Fatal Rapunzel Syndrome

Fatal Rapunzel Syndrome

Pharmacobezoar-Related Fatalities: A Case Report and a Review of the Literature

Pharmacobezoar Masquerading as a Colon Lesion: A Sticky Situation

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