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.