CASE REPORT
A 53-year-old woman with previous tobacco use was incidentally found to have a hemoglobin level of 6.7 g/dL, hematocrit of 24%, and mean corpuscle volume of 69 fL on evaluation for urinary tract infection. Laboratory evaluation was consistent with iron deficiency anemia. Given her unexplained iron deficiency anemia, esophagogastroduodenoscopy and colonoscopy were planned for further evaluation. Esophagogastroduodenoscopy revealed LA grade C esophagitis and 3-cm hiatal hernia, which were considered the most likely causes of her iron deficiency anemia. During the colonoscopy, numerous foreign bodies were found filling the cecum, throughout the colon, and lodged in several diverticular lumens (Figure 1).
Figure 1.
Colonoscopy showing ingested nicotine gum at the (A) cecum, (B) appendiceal orifice, (C) diverticula at the level of the sigmoid colon, and (D) at the level of the hepatic flexure.
With the patient's assistance, these were identified as ingested nicotine gum. She endorsed chewing and swallowing approximately 25 pieces of gum per day for the past 3 years. We estimate there were no less than 30 pieces of gum present in the cecum. The gum throughout the colon was adhered to the colon wall but was easily removed with a flush. The pieces impacted in the diverticulum were not able to be readily flushed out and were left in place. These images of chewing gum in the adult gastrointestinal tract represent a rare finding on endoscopy.
Similar cases with chewing gum bezoars in the rectum, requiring manual removal, and a coin-gum mass presenting as esophageal obstruction have been recorded in pediatric patients.1 There are only 3 documented cases in adult patients. The most notable case discovered a gum bezoar lodged in the colon incidentally because of a false positive positron emission tomography.2 There is no known causality between ingesting chewing gum and disease currently. We believe encouraging patients to discard chewing gum rather than ingesting is necessary for patients using large amounts of chewing gum daily, although it is obvious.
DISCLOSURES
Author contributions: JS Magee wrote and edited the manuscript and is the article guarantor. SJ Bernick edited the manuscript.
Financial disclosure: None to report.
Informed consent was obtained for this case report.
REFERENCES
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