Gastric bezoar with associated gastrocolic fistula in a patient with learning disabilities

Bezoars are foreign bodies formed by indigestible material that can form in the gastrointestinal tract, most often in the stomach. Gastric bezoars can be managed by endoscopic or surgical approaches. An elderly woman with a background of learning disabilities, known to be consuming non-food items, presented with abdominal pain and vomiting. Computed tomography imaging demonstrated stomach wall thickening and a large gastric bezoar was identified endoscopically. Following a multidisciplinary team meeting, she underwent a laparotomy, gastrostomy and removal of the bezoar. Intraoperatively, a gastrocolic fistula was identified and surgically repaired. Postoperatively, the patient developed a gastrocutaneous fistula requiring ultrasound-guided drainage. She subsequently developed a chest infection and passed away 24 days postoperatively. Management of gastric bezoars can be difficult, with large bezoars often requiring surgical intervention. In a patient with learning disabilities, early multidisciplinary team involvement is key to allow for timely therapeutic intervention.