Gastric and Pan-Colonic Cement Bezoars Secondary to Pica in an Elderly Man

CASE REPORT An 82-year-old man with a 10-year history of intractable pruritus and untreated depression presented with progressive abdominal distension. He had ingested 50 g of cement powder daily for 1 week, believing it would relieve his itch. Computed tomography revealed a 6.3 × 3.0-cm gastric cast-like mass and multiple high-density nodules throughout the ascending, transverse, descending, and sigmoid colon (Figure 1). The jejunum and ileum were dilated, suggesting obstruction, but no intraluminal calculi were present (Figure 2). In this carefully selected patient, conservative management (nil by mouth, intravenous fluids, oral liquid paraffin 30 mL daily) resolved symptoms within 3 days, likely because of passage of cement debris. Surgery was declined after shared decision making. At 1-month follow-up, the patient tolerated a semi-solid diet and had ceased cement ingestion. No follow-up imaging was obtained as the patient remained asymptomatic and declined further investigation. Surgical intervention would be indicated if conservative management fails, obstruction worsens, or complications such as perforation occur.Figure 1.: Abdominal computed tomography showing gastric cast and transverse colon nodules.Figure 2.: Abdominal computed tomography showing multiple high-density nodules in the ascending, descending, and sigmoid colon, with small bowel dilatation.Cement bezoars are extremely rare, with only 3 previously reported cases (1986 surgery, 2015 endoscopy, 2022 suicide attempt surgery).1–3 This is the first reported case with pan-colonic involvement and successful conservative management. Pica should be considered in elderly patients with chronic, untreated pruritus.4 In frail elderly patients with widespread, surgically challenging foreign bodies, nonoperative management may be a reasonable alternative to high-risk surgery. DISCLOSURES Author contributions: M. Hu: Attending physician for the case; acquisition, analysis, and interpretation of data; literature review; drafting and critical revision of the manuscript; final approval. T. Lin: Clinical supervision; manuscript review; final approval. X. Chen: Conceptualization; supervision; writing—review and editing; final approval; corresponding author, and is the article guarantor. Financial disclosure: None to report. Informed consent was obtained for this case report.