S4718 Phytobezoar-Related GI Hemorrhage in the Elderly: An Underrecognized Cause of Upper GI Bleeding

Introduction: Phytobezoars are rare, indigestible plant fiber aggregates typically found in the stomach. Though more often associated with obstruction, they are an underrecognized cause of upper gastrointestinal bleeding (UGIB), especially in elderly or high-risk patients. Case Description/Methods: An 84-year-old man with atrial fibrillation on warfarin, HFrEF (EF 20–25%), coronary artery disease, AAA, and prior CVA presented with fatigue, hypotension, and melena. He was pale and hypotensive (BP 74/46 mmHg), requiring intensive care unit admission for hemorrhagic shock. Labs showed Hgb 8.0 g/dL and INR 2.3. He received packed red blood cells and FFP. esophagogastroduodenoscopy on day 1 revealed a large gastric cardia phytobezoar with bleeding at the gastroesophageal junction and LA Grade A esophagitis. The bezoar was removed endoscopically. Post-procedure, he developed respiratory failure due to left-sided whiteout and mucus plugging, requiring intubation and vasopressors. He improved with bronchoscopy and was treated for aspiration pneumonia. A modified barium swallow confirmed aspiration; a dysphagia diet was initiated. He was transitioned to the medicine floor with palliative support. Discussion: Phytobezoars can cause UGIB via pressure-induced ulceration, particularly in elderly or gastroparetic patients. Up to 82% of bezoars are associated with mucosal ulceration, with nearly half presenting with overt bleeding. Endoscopy is key for diagnosis and therapy. Bleeding severity does not correlate with bezoar size or duration. Early intervention, including endoscopic removal and follow-up, is crucial. Risk reduction strategies include dietary changes and prokinetic therapy.