Title:Clinical and Forensic Aspects of Pharmacobezoars
Volume: 12
Issue: 2
Author(s): Francisco Basílio*Ricardo Jorge Dinis-Oliveira*
Affiliation:
- Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Porto,Portugal
- Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Porto,Portugal
Keywords:
Pharmacobezoar, pathophysiology, signs and symptoms, clinical and forensic diagnosis, treatment, laparotomy.
Abstract:
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.
