Importance of abdomen CT scan and gastroscopic pharmacobezoar removal following massive acute drug overdose

Objectives : Pharmacobezoar formation following massive drug ingestion could be an important life risk during the treatment of acute drug overdoses (1). Case series: We describe three cases of pharmacobezoar formation following massive drug ingestion; the importance of CT evaluation as a diagnostic tool and upper GI endoscopy removal as a decontaminating technique. Headings: three patients were admitted to the Emergency Department (ED) with life-threatening signs and symptoms for psycho-active drug overdose requiring advanced life support. All patients underwent gastric lavage with a large bore orogastric probe (42 French). Considering the high number of ingested tablets (mean of 109 tablets per patients), drugs formulation (extended release drug) and serious clinical symptoms presented at the admission to ED, abdomen tomography was performed in order to reveal gastric drug bezoar formation. Abdomen CT-scan revealed the presence of gastric bezoars in each patient. Subsequently, upper GI endoscopy was performed and the bezoar successfully removed thus reducing drugs absorption. Average time for eyes opening and extubation was 33±7 hours (mean±SD), average length of stay was 10±3 days (mean±SD). No mechanical complications due to repeated upper GI endoscopy were reported. Conclusion: in every massive drug overdose above all in the case of extended release drug formulations, pharamcobezoar formation should be suspected. Therefore, abdomen CT scan should be performed in order to proceed to adequate GI decontamination by upper GI endoscopy pharmacobezoar removal and to improve patients clinical outcome.