A Scope Is Worth a Thousand Words: A Case of Foreign Body Ingestion in Non-verbal Adults With Autism
Bibliographic record
Abstract
Gastrointestinal (GI) bezoars are concretions of food or foreign material in the GI tract that cause serious medical and sometimes surgical problems. Bezoars are a rare cause of gastric outlet obstructive symptoms including nausea, vomiting, and epigastric pain. We report an unusual case of bezoar in a patient with underlying Autism. A 24-year- old male with a history of autism presented with nausea and vomiting of insidious onset and unknown duration. Patient was nonverbal and history was obtained by his mother. His physical examination and laboratory results were unremarkable. Abdominal X ray and CT scan showed a variety of foreign bodies in different parts of the GI tract (Fig 1). He underwent an upper GI endoscopy which revealed entangled and retained objects between the gastric folds. They included wires, Gatorade caps, gauze pieces, shirt labels, shoe laces, pens, highlighters, hair, plastic tubing, and zippers (Fig 2). A portion of the objects were denatured by gastric acid and underwent oxidation. Food debris were also enmeshed in the mix. Esophagitis, gastritis, and gastric erosions were noted. The bulk of the bezoar was removed endoscopically, and the most concrete part left behind and patient was treated conservatively. Bezoars are classified according to their composition which include phytobezoars, trichobezoars, and pharmacobezoars. Trichobezoars are commonly found in patients with underlying psychiatric illness such as trichotillomania and trichophagia. This kind of bezoar is rare as affected patients remain asymptomatic for many years. Symptoms include abdominal pain, nausea, vomiting, halitosis, early satiety, anorexia, and weight loss. Intestinal bezoars are often found in association with gastric bezoars. Coexisting gastric bezoars was reported in 17%-21% of patient. Up to 20% of patients have recurrent bezoars. As this disease presentation is insidiouse and non specific, it is imperative to prioritize it on the differential diagnosis in patients with underlying psychiatric illness.Figure: Plain abdominal XR revealing multiple different objects in stomach and in small bowel.Figure: Bezoar containing multiple Different objects visualized on EGD.Figure: Removed Bezoar with objects exposed containing shoe laces, plastic bottle caps, hair, shirt tags and more.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.003 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.004 | 0.002 |
| Insufficient payload (model declined to judge) | 0.009 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".