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Endoscopic removal of slow release clomipramine bezoars in two cases of acute poisoning.

Author(s): Hojer J, Personne M

Affiliation(s): Swedish Poisons Information Centre, Stockholm, Sweden. jonas.hojer@apoteket.se

Publication date & source: 2008-04, Clin Toxicol (Phila)., 46(4):317-9.

Publication type: Case Reports

INTRODUCTION: Acute gastroscopy is seldom advocated in cases of drug overdose. However, this intervention is sometimes recommended in cases where a pharmacobezoar of toxic tablets has formed. CASE REPORTS: We describe two patients who were admitted after major ingestion of slow release clomipramine. In one case an abdominal x-ray was highly suspicious of a large pharmacobezoar in the stomach and in the other case a tablet conglomerate totally obstructed the oesophagus. Both conditions were successfully managed by acute gastroscopy. DISCUSSION: There are limited and inconclusive recommendations in the literature concerning the optimal treatment of pharmacobezoars. CONCLUSION: This article provides further evidence that slow release clomipramine may be capable of forming a radio-opaque pharmacobezoar. The clinical courses in these two cases suggest that tablet removal by gastroscopy should be considered in selected cases of drug poisoning. Suspicion of a pharmacobezoar may warrant diagnostic investigations such as imaging studies and endoscopy.

Page last updated: 2008-06-22

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