Oesophageal Obstruction from a Pharmacobezoar Resulting in Death

Mortensen, K.; Munkholm, Julie; Dalhoff, Kim; Hoegberg, Lotte Christine Groth

doi:10.1111/bcpt.12662

Cited by 8 publications

(5 citation statements)

References 28 publications

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“…To our knowledge, 2 other cases have been reported in the literature involving the use of postmortem imaging in characterizing a bezoar. The first is from Mortensen et al 36 in which an 84-year-old man died of a pharmacobezoar. The authors stated that the PMCT scan identified tablet residues within his stomach.…”

Section: Discussionmentioning

confidence: 99%

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%

Fatal Rapunzel Syndrome

Żyła

Jacques

2023

Am J Forensic Med Pathol

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“…Other similar cases have been published, involving a wide range of medications. 8,12,14,16,17,20,22 Another important point must also be taken into consideration to explain these toxicokinetic alterations. Indeed, several of these reported cases involved ER or SR formulations.…”

Section: Discussionmentioning

confidence: 99%

“…Seventeen publications describing 19 cases of pharmacobezoar-related fatalities have been published between 1939 and 2021. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Decedents' mean age was 47.6 years (0.8-79). The male/female ratio was 13:6.…”

Section: Literature Reviewmentioning

confidence: 99%

“…[7][8][9][10][11][12][13][14][15][16][17][18][21][22][23] Death was attributed to drug toxicity in 13 cases (single-drug intoxication: 11 cases; multidrug intoxication: 2 cases). 8,[12][13][14][15][16][17][18][19][20][21][22][23] A mixed cause of death (CoD) involving mechanical complications and drug toxicity was reported in 2 cases. 19 In another case, death was attributed to drug and carbon monoxide toxicity.…”

Section: Literature Reviewmentioning

confidence: 99%

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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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“…At pH 3.5 or 6.5, ASA's intestinal absorption is higher than the gastric absorption of the compound. The stomach does not absorb ASA at pH 6.5 [11,12]. ASA elimination happens throughout dual pathways via the invention of salicyluric acid and salicyl phenolic glucuronide.…”

Section: Figure1 Mechanism Of Action Of Aspirinmentioning

confidence: 99%

General Explanation of Aspirin: Recent and Future Advancement

Bereda¹

2022

JPPR

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Salicylates have been derived from the willow tree bark. Acetylsalicylic acid has analgesic, antipyretic and anti-inflammatory actions. Salicylate elimination happens throughout dual pathways via the invention of salicyluric acid and salicyl phenolic glucuronide. Salicylic acid is renally cleared, which can be escalated by ascending the urinary pH. Medicines like antacids can accelerate renal clearance as they ascend urinary pH. Aspirin should be used with chariness in children taking some distinctive medications. Levels of methotrexate, valproic acid, phenytoin, and disparate non-steroidal anti-inflammatory drugs (tolmetin, diclofenac) perhaps escalated in children who are also taking aspirin.

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Oesophageal Obstruction from a Pharmacobezoar Resulting in Death

Cited by 8 publications

References 28 publications

Fatal Rapunzel Syndrome

Fatal Rapunzel Syndrome

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

General Explanation of Aspirin: Recent and Future Advancement

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