Woman hospitalized with pain and vomiting—diet soda cured her

A 63-year-old woman arrived at the emergency department of Brigham and Women’s Hospital in Boston suffering from intense stomach pain, nausea, and vomiting. Over the course of a month, she experienced debilitating symptoms, including severe nausea and burning pain that radiated from her upper abdomen to her right side and around to her back. Despite her efforts to find relief, nothing seemed to work. As doctors began to delve into her medical history, they discovered it was extensive. The patient had several underlying conditions, including Type 2 diabetes, Stage 2 chronic kidney disease, and gastroesophageal reflux disease (GERD), in addition to a history of opioid use disorder. Notably, she had been taking semaglutide, a medication used for weight loss, which had helped her shed approximately 40 pounds—over 19% of her body weight—in the past year. In an intriguing case report published in the New England Journal of Medicine, the medical team outlined their diagnostic journey and eventual treatment, which turned out to be surprisingly straightforward. After conducting lab tests and imaging studies, the woman was admitted to the hospital for further evaluation. A CT scan of her abdomen revealed an enlarged bile duct and a stomach filled with a semi-solid mass. Similarly, an MRI indicated the presence of a mass that appeared mottled, likely due to air bubbles, alongside bile duct enlargement, potentially linked to her opioid use or the formation of a gastric bezoar. Gastric bezoars are masses that can form in the stomach from various materials, with phytobezoars being the most common. These are typically formed from indigestible fruit and vegetable components. A specific type, known as diospyrobezoar, can occur from excessive consumption of persimmons, whose skin contains tannins that create a sticky substance in the presence of gastric acid—making them particularly challenging to treat. The case highlights an unusual yet effective intervention that ultimately led to the patient's recovery.