Ivermectin Bezoar: An Unusual Case Presentation

Key Takeaways for GI Nurses

• Ivermectin, an antiparasitic medication that gained widespread attention during the COVID-19 pandemic, can form bezoars when taken inappropriately or in excessive quantities
• Medication-induced bezoars represent an uncommon but serious complication that may present with symptoms similar to other gastrointestinal obstructions, requiring careful assessment and endoscopic intervention
• Thorough medication history taking should include over-the-counter supplements, veterinary medications, and any self-prescribed treatments, as patients may not readily volunteer this information
• Recognition of unusual bezoar presentations expands the differential diagnosis for gastric outlet obstruction and emphasizes the importance of considering pharmacological causes in unexplained cases

Clinical Relevance

This case report highlights an emerging concern for gastroenterology nursing professionals as medication-induced bezoars become increasingly recognized complications of inappropriate drug use. The formation of an ivermectin bezoar demonstrates how non-traditional medications can create complex clinical presentations that require specialized endoscopic management. For GI nurses, this underscores the critical importance of comprehensive medication reconciliation during patient intake, particularly when patients present with symptoms of gastric obstruction or unexplained abdominal complaints.

From a procedural standpoint, this case reinforces the need for endoscopy nurses to be prepared for complex therapeutic interventions beyond routine diagnostic procedures. Bezoar removal often requires specialized equipment, extended procedure times, and careful coordination between the nursing team and gastroenterologist. Nurses must be familiar with various retrieval devices, fragmentation techniques, and potential complications associated with bezoar extraction. Additionally, this case emphasizes the importance of post-procedure monitoring, as patients may experience delayed complications or require repeat interventions for complete bezoar clearance.

The increasing prevalence of self-medication with alternative treatments, particularly following the COVID-19 pandemic, creates new challenges for gastroenterology units. Nurses must maintain awareness of trending medications and supplements that patients may be taking outside of traditional medical supervision. This knowledge enables more effective patient education, earlier recognition of medication-related complications, and improved communication with the healthcare team about potential pharmaceutical causes of gastrointestinal symptoms.

Bottom Line

This unusual case of ivermectin bezoar formation serves as a reminder that GI nurses must remain vigilant for medication-induced complications, even from unexpected sources, and emphasizes the critical role of thorough medication history taking and patient education in preventing such complications. As self-medication practices continue to evolve, endoscopy nurses should be prepared to encounter and manage bezoars formed from non-traditional pharmaceutical agents, ensuring they have the clinical knowledge and procedural skills necessary to support safe, effective endoscopic interventions.