Ivermectin Bezoar: An Unusual Case Presentation

Key Takeaways for GI Nurses

• Ivermectin tablets can form bezoars when taken in excessive quantities, presenting as an unusual cause of gastric obstruction that may require endoscopic intervention
• Patient medication history assessment should include specific questioning about over-the-counter supplements and alternative treatments, particularly during periods when non-prescription ivermectin use was prevalent
• Bezoar formation from pharmaceutical agents requires careful endoscopic evaluation and may necessitate specialized removal techniques depending on the consistency and adherence of the mass
• This case highlights the importance of maintaining clinical awareness of emerging toxicology presentations that may present to the endoscopy suite as foreign body or obstruction cases

Clinical Relevance

This unusual case presentation has significant implications for gastroenterology nursing practice, particularly in pre-procedure assessment and patient safety protocols. As endoscopy nurses, we must expand our differential diagnosis thinking when encountering patients with gastric obstruction symptoms. The formation of pharmaceutical bezoars from ivermectin represents a relatively new clinical entity that requires specific attention during patient intake processes. Nurses should be prepared to ask detailed questions about recent medication use, including non-prescription treatments and supplements that patients may not initially consider relevant to their gastrointestinal symptoms.

From a procedural standpoint, this case underscores the importance of thorough endoscopic evaluation when bezoars are suspected. Ivermectin bezoars may have different physical characteristics compared to traditional food bezoars, potentially requiring modified removal techniques or equipment. Endoscopy nurses should ensure that appropriate accessories for bezoar fragmentation and removal are readily available, and should be prepared for potentially longer procedure times when dealing with pharmaceutical masses that may be more adherent or difficult to break apart than organic material.

This case also reinforces the critical role of nursing staff in patient education and discharge planning. Following successful removal of an ivermectin bezoar, nurses must provide clear counseling about appropriate medication use and the risks associated with excessive consumption of any pharmaceutical agent. Documentation should include detailed medication reconciliation and patient education provided, as these cases may have implications for ongoing patient safety and potential toxicology follow-up.

Bottom Line

Ivermectin bezoar formation represents an emerging clinical presentation that gastroenterology nurses must recognize and be prepared to manage through comprehensive medication history taking, appropriate procedural preparation, and thorough patient education about safe medication practices to prevent recurrence.