Surgeons operating on a 21-year-old woman knew her stomach was packed with foreign material. They removed 3,000 grams, about 6.6 pounds, of plastic bags and bottle fragments, plastic caps, candy wrappers, adhesive tape, hair, plant fibers, and metal staples.
Then they found something the scans had not shown. A second, separate mass weighing 500 grams, about 1.1 pounds, was blocking the upper part of her jejunum, the middle section of the small intestine.
The case was described in a case report in Cureus published Sept. 16, 2026. The patient had autism spectrum disorder, mild intellectual disability, previously diagnosed pica, and a seizure disorder treated with carbamazepine.
A Month of Fever, Pain and a Swelling Belly
She arrived after nearly a month of recurring fever, cramping abdominal pain, steadily increasing bloating, feeling full quickly, constipation and vomiting of food. Doctors felt a firm, poorly defined mass in her upper and middle abdomen, without signs of irritation of the abdominal lining. Blood tests showed an elevated white blood cell count.
An abdominal X-ray showed a markedly enlarged stomach with a mottled pattern inside. A CT scan found her stomach almost filled with solid material of mixed density, and an upper endoscopy confirmed a large mass of foreign material.
Masses like these are called bezoars, clumps of indigestible material trapped in the digestive tract. The authors noted that bezoars can cause blockage, ulcers, bleeding or perforation, and that mixed-material bezoars containing nonfood objects are uncommon.
The Second Bezoar the Scans Missed
During open abdominal surgery, the team confirmed a severely enlarged stomach and removed the gastric bezoar through a 15-centimeter incision in the stomach wall. The jejunal blockage, which had not been identified before the operation, came out through a separate 5-centimeter incision in the intestine.
The two masses were not physically connected. That distinguishes the case from Rapunzel syndrome, in which a hair mass extends from the stomach into the intestine like a tail.
Other reports show that continuous pattern. In a Cureus report on Rapunzel syndrome, a 9-year-old girl with nonverbal autism, pica, and hair-pulling disorder had a bezoar stretching from her stomach through most of her small intestine, causing multiple intussusceptions, in which one section of bowel slides into another.
An earlier pediatric surgery case report described a young girl with autism whose giant bezoar filled her stomach, her duodenum, and about 60 to 70 centimeters of her jejunum. Initial imaging pointed to an intussusception before CT suggested swallowed foreign material.
The new report's warning is different. Because a separate mass farther down can go undetected, the authors urged clinicians to consider synchronous distal bezoars, meaning additional masses lower in the gut, in patients with severe pica and a massive stomach bezoar, particularly when imaging shows only the dominant stomach lesion.
Pica, Autism and a Risk That Builds Quietly
Pica is a pattern of eating nonfood materials that must last at least a month to fit the diagnosis, according to the National Library of Medicine's MedlinePlus. It is seen more in young children, with up to one-third of kids ages 1 to 6 showing these eating behaviors. It can also occur during pregnancy, sometimes linked to shortages of nutrients such as iron and zinc. In some cases, it continues into the teen years or adulthood, especially alongside developmental disorders. MedlinePlus lists bezoars, infection, and lead poisoning among the complications.
A report in the International Journal of Surgery Case Reports noted that autistic people face a greater risk of digestive problems, including chronic constipation and acute intestinal obstruction from pica-related bezoars. That report described an 11-year-old autistic boy whose blockage was caused by bezoars in the colon and rectum.
Bezoars can cause subtler harm as well. In a report on a 38-year-old woman with nonverbal autism, intellectual disability, and pica, French doctors concluded that a gastric bezoar likely slowed absorption of the pain drug tramadol, contributing to an opioid overdose and serotonin syndrome.
The Cureus report describes one patient, so it cannot show how often second bezoars occur in people with pica. It does highlight a practical point for surgical teams: the largest mass may not be the only one.
Recovery, and the Harder Problem of Prevention
Surgeons closed both incisions in two layers. The woman began drinking liquids on the fifth day after surgery and went home on day eight, with no leak, infection, or other surgical complication. Checkups one week and one month after discharge showed a favorable recovery.
Surgery removes the mass, not the behavior behind it. MedlinePlus says treating pica involves behaviors, the environment, and family education, and that medicines may help reduce the behavior when pica is part of a developmental disorder such as intellectual disability.
MedlinePlus advises contacting a health care provider when a child or adult is eating nonfood materials. It also notes that a blockage in the stomach or intestine can cause belly pain, nausea, and bloating, symptoms that should prompt a call to a clinician in someone known to swallow nonfood items.
Key Questions Answered
What did surgeons find?
A 3,000-gram bezoar in the stomach and a separate 500-gram bezoar blocking the jejunum, which imaging had not identified before surgery.
What was inside the masses?
Plastic bags and bottle fragments, plastic caps, candy wrappers, adhesive tape, hair, plant fibers and metal staples.
How is this different from Rapunzel syndrome?
In Rapunzel syndrome, a hair mass extends from the stomach into the intestine. In this case, the two masses were not connected.
What is pica?
A pattern of eating nonfood materials that lasts at least a month. It can continue into adulthood, especially with developmental disorders.
How did the patient recover?
She started liquids on day five, went home on day eight without surgical complications and was recovering well at one month.
What should caregivers watch for?
Repeated eating of nonfood items, along with belly pain, bloating, nausea or vomiting, should prompt a call to a health care provider.
