Mitchell C, Repp A (2014) Bubble Gum Bezoar. JSM Clin Case Rep 2(3): 1035.

A 58 year old gentleman was admitted to our hospital for further management of a transgastric jejunostomy tube that had developed worsening insertion site drainage with surrounding skin maceration and pain. His past medical history was notable for morbid obesity, diabetes mellitus, carcinoid tumor of the small bowel, chronic fatigue and chronic headaches. His surgical history was notable for gastric restriction surgery, gastric bypass surgery, cholecystectomy, and appendectomy. A gastrostomy tube was originally placed 19 months prior due to severe malnutrition following gastric bypass surgery and eventually it had been converted to a 24 French transgastric jejunostomy tube.

In an attempt to improve the insertion site drainage, the 24 French transgastric jejunostomy tubes were changed to a 16 French transgastric jejunostomy tube. During the procedure, internalized portions of the ostomy tube were observed to be coated in a thick substance that smelled like bubble gum (Figure 1).

Figure 1 Removed 24 French Transgastric jejunostmy tube showing adherent bubble gum.

Upon further discussions with the patient, he confirmed the only solid substance he put in his mouth during the past year for comfort was bubble gum, which he chewed many times each day. He routinely swallowed his gum.

To evaluate further for retained bubble gum, a fluoroscopic upper GI series with small bowel follow-through study was performed and showed an area of decreased filling consistent with a “bubble gum bezoar” (Figure 2).

Figure 2 Upper GI series showing a large heterogeneous filling defect in the gastric antrum with complex surface characteristics, compatible with history of retained bubble gum, with passage of contrast into the small bowel.

Upper endoscopy performed the next day was limited by retained barium but did not find the “bubble gum bezoar.” The patient was advised to no longer swallow his bubble gum. His new transgastric jejunostomy tube functioned well but continued to have ongoing leakage at the insertion site. He was discharged shortly after his procedure with wound care follow up.