Abstract
A pathology consult was initiated regarding a 75-year-old female with a chief complaint of pea-sized yellow balls in her stool (Fig. 1). Her medical history included irritable bowel syndrome, multiple sclerosis, and trigeminal neuralgia with prescriptions for extended-release carbamazepine, atenolol, buspirone, and gabapentin. The patient noted that the ball-shaped objects retrieved from the stool contained white fluid when opened. Her physician placed an order for “stool microscopic.” ... Potential foreign objects in stool include parasite structures (1), dietary plant material (2), illicit drug packing, accidentally ingested foreign bodies, capsule endoscopy, and undigested coatings of modified-release (-ER/-XR/-EC/-SR/-CR) medication (3, 4). While the patient and clinician claimed no changes to diet or medication, the carbamazepine prescription had recently changed to Tegretol-XR (extended-release) (see online Supplemental Fig. 1). The medication package insert states: “…tablet coating is not absorbed and is excreted in the feces…” (5). Supplementary material is available at Clinical Chemistry online.
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