von Düring Stephan, Challet Corinne, Christin Laurent
Department of Internal Medicine, Emergency Medicine and Critical Care Medicine, Groupement Hospitalier de l'Ouest Lémanique (GHOL), Nyon Hospital, Chemin Monastier 10, 1260, Nyon, Switzerland.
Department of Pharmacy, Pharmacie Interhospitalière de la Côte, Chemin du Crêt 2, 1110, Morges, Switzerland.
J Med Case Rep. 2019 Feb 27;13(1):45. doi: 10.1186/s13256-019-1984-0.
Gastric pharmacobezoars are a rare entity that can induce mechanical gastric outlet obstructions and sometimes prolong toxic pharmacological effects. Certain medications, such as sustained-release forms, contain cellulose derivatives that may contribute to the adhesion between pills and lead to the creation of an aggregate resulting in a pharmacobezoar. Case reports are rare, and official guidelines are needed to help medical teams choose proper treatment options.
Our patient was a 40-year-old Caucasian woman with borderline personality disorder and active suicidal thoughts who was found unconscious after a massive drug consumption of slow-release clomipramine, lorazepam, and domperidone. On her arrival in the emergency room, endotracheal intubation was preformed to protect her airway, and a chest x-ray revealed multiple coffee grain-sized opaque masses in the stomach. She was treated with activated charcoal followed by two endoscopic gastric decontaminations 12 h apart in order to extract a massive gastric pharmacobezoar by manual removal of the tablets.
This case demonstrates that in the case of a massive drug consumption, a pharmacobezoar should be suspected, particularly when cellulose-coated pills are ingested. Severe poisoning due to delayed drug release from the gastric aggregate is a potential complication. Detection by x-ray is crucial, and treatment is centered on removal of the aggregate. The technique of decontamination varies among experts, and no formal recommendations exist to date. It seems reasonable that endoscopic evaluation should be performed in order to determine the appropriate technique of decontamination. Care should be patient-oriented and take into account the clinical presentation and any organ failure, and it should not be determined solely by the suspected medication ingested. Thus, serum levels are not sufficient to guide management of tricyclic antidepressant intoxication.
胃内药物性胃石是一种罕见的病症，可导致机械性胃出口梗阻，有时还会延长药物的毒性药理作用。某些药物，如缓释剂型，含有纤维素衍生物，可能会促进药丸之间的粘连，导致形成聚集体，进而形成药物性胃石。病例报告很少见，需要官方指南来帮助医疗团队选择合适的治疗方案。
我们的患者是一名40岁的白种女性，患有边缘性人格障碍且有自杀念头，在大量服用缓释氯米帕明、劳拉西泮和多潘立酮后被发现昏迷。她到达急诊室后，进行了气管插管以保护气道，胸部X光显示胃内有多个咖啡粒大小的不透明团块。她接受了活性炭治疗，随后每隔12小时进行两次内镜下胃去污，以便通过手动取出药片来清除巨大的胃内药物性胃石。
该病例表明，在大量服药的情况下，应怀疑药物性胃石，尤其是在摄入包有纤维素的药丸时。胃内聚集体延迟释放药物导致的严重中毒是一种潜在并发症。通过X光检测至关重要，治疗的核心是清除聚集体。去污技术在专家之间存在差异，目前尚无正式建议。进行内镜评估以确定合适的去污技术似乎是合理的。护理应以患者为导向，考虑临床表现和任何器官衰竭，不应仅由怀疑摄入的药物来决定。因此，血清水平不足以指导三环类抗抑郁药中毒的管理。
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