Gastro-esophageal pharmacobezoar

A 35-year-old man with schizophrenia died from an overdose of propranolol (blood level = 60 mg/L). Post mortem CT scanning showed marked distension of the esophagus by granular material with a bolus of similar material within the stomach. At autopsy 62 g of lime green pharmacobezoar was present within the esophagus with an additional 130gm mass of similar material within the stomach, both of which contained propranolol. The rest of the gastrointestinal tract was unremarkable. The mouth, pharynx, glottis, larynx, trachea and bronchi were all structurally normal with no obstructive material. Thus, there was no evidence of airway compromise to suggest that the bezoar had mechanically contributed to death. Rather, elution of the drug had resulted in lethal blood levels. The color of the pharmacobezoar derived from the green color of certain propranolol tablets. Death was therefore attributed to propranolol toxicity with an associated finding of a massive gastro-esophageal pharmacobezoar.