The symptoms: The patient went to the emergency department after experiencing nausea and vomiting for about a month, along with decreased appetite. She told doctors that she'd also experienced a burning pain in her upper abdomen and right side of her torso, which wrapped around to her back. She'd tried treating these symptoms with two common over-the-counter medications for acid reflux, but the treatments didn't help.
What happened next: Doctors took a CT scan of the patient's abdomen and pelvis. This revealed that the bile ducts, which move bile from the liver to the gallbladder and small intestine, were slightly dilated. The woman also had "heavy stool burden" but no signs of obstructions in her bowels, and her stomach was slightly stretched out due to carrying "semisolid material."
The diagnosis: The endoscopy revealed a large mass in the woman's stomach, known as a gastric bezoar. These masses are tightly packed blobs of partially digested or undigested materials.
The next step with a bezoar is to try and dissolve the mass while it's still in the stomach — and evidence suggests a good way to do this is to give the patient soda.
Due to the patient's history of diabetes, she was given diet cola. She also didn't enjoy carbonated beverages, so the typical prescription of 3 liters of soda was cut down to 1.5 liters (0.4 gallons). On the second day after starting this treatment, the patient noted a "tugging" sensation in her abdomen followed by relief of her nausea and abdominal discomfort. An endoscopic exam revealed that the bezoar was no longer stuck in her stomach.
What makes the case unique: Gastric bezoars are fairly rare, the report noted. They are found in less than 0.5% of endoscopies of the upper digestive tract. Common symptoms of the condition, such as pain, nausea, vomiting and abdominal discomfort, also appear in many more-common disorders, so they don't necessarily point to the presence of a bezoar in all cases.
However, various medical conditions, procedures and drugs can also raise the risk of bezoars. These include anatomical changes related to bariatric or other gastric surgeries, autonomic nerve damage, and medications that cause delayed gastric emptying, such as GLP-1s. In the woman's case, semaglutide was likely to blame for her bezoar, and discontinuing the treatment helped resolve the problem.
OTHER DILEMMASThe cola she consumed also helped. Although that course of treatment sounds strange on paper, it is the preferred first-line treatment over using a scope to physically break up the bezoar in the patient's stomach.
For more intriguing medical cases, check out our Diagnostic Dilemma archives.
This article was first published Oct. 15, 2025.
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