Giant Mixed-Material Gastric Bezoar With a Synchronous Jejunal Bezoar in a Young Woman With Pica and Autism Spectrum Disorder: A Case Report

Bezoars are conglomerates of indigestible material retained within the gastrointestinal tract and may produce obstruction, ulceration, bleeding, or perforation.Mixed-material bezoars containing nonfood foreign bodies are uncommon and may be particularly challenging in patients with persistent pica.We report a 21-year-old woman with autism spectrum disorder (ASD), mild intellectual disability, previously diagnosed pica, and a seizure disorder treated with carbamazepine who presented after nearly one month of recurrent fever, colicky abdominal pain, progressive distension, early satiety, constipation, and nonbilious alimentary vomiting.Examination demonstrated abdominal distension and a firm, poorly defined epigastricmesogastric mass without peritoneal irritation.Leukocytosis with neutrophilia was present.Abdominal radiography showed marked gastromegaly with mottled intragastric radiolucency, and computed tomography (CT) demonstrated a stomach almost completely occupied by heterogeneous solid material.Upper endoscopy confirmed a large gastric foreign-body mass.Exploratory laparotomy revealed marked gastromegaly and, unexpectedly, a separate bezoar obstructing the proximal jejunum that had not been identified preoperatively.A 15-cm anterior gastrotomy permitted removal of 3,000 g of material, and a 5-cm antimesenteric jejunotomy permitted removal of an additional 500 g.The two masses were not physically connected and contained plastic bags and bottle fragments, plastic caps, candy wrappers, adhesive tape, hair, plant fibers, and metallic staples.Both enteric incisions were closed in two layers, with an outer Lembert layer.Oral liquids were initiated on postoperative day 5 and advanced as tolerated; the patient was discharged on postoperative day 8 without leak, infection, or other surgical complications.Follow-up at one week after discharge and at one month showed favorable recovery.This case highlights the diagnostic importance of considering synchronous distal bezoars in patients with severe pica and a massive gastric bezoar, particularly when preoperative imaging identifies only the dominant gastric lesion.