Document Type

Article

Publication Date

3-2025

Identifier

DOI: 10.1016/j.epsc.2024.102954

Abstract

Introduction

Trichobezoars are a rare cause of gastrointestinal obstruction in children. Trichobezoars are primarily confined to the stomach but in some cases can grow to substantial sizes and extend into the duodenum. Most trichobezoars require surgical removal through an often large gastrotomy.

Case presentation

A previously healthy 15-year-old female presented with 4 days of nausea, vomiting, and diarrhea. Examination was concerning for hypotension, severe abdominal distension, and diffuse peritonitis. Abdominal x-ray showed distended bowel loops in the upper abdomen and concern for pneumoperitoneum. Laboratory studies showed leukocytosis, anion gap metabolic acidosis, and acute kidney injury. The patient underwent emergent exploratory laparotomy which revealed a massive trichobezoar (42 cm × 12 cm) with distal portion in the duodenum, a closed loop obstruction of small bowel with a small trichobezoar in the proximal jejunum with bowel necrosis nearby, and pneumatosis from the proximal ileum to the transverse colon. The patient underwent anterior gastrotomy with successful removal of the bezoar in a single piece. During removal of the bezoar, we utilized a hydrodissection technique with warm saline that allowed separation of the entwined hairs from the gastric mucosa while also making the mass malleable as it absorbed the liquid. Additionally, she underwent small bowel resection x2 and temporary abdominal closure with wound vac placement. She returned to the OR two more times for washout and eventual anastomosis of small bowel and abdominal closure. Her post-operative course was complicated by refeeding syndrome, and she was discharged on POD 17 tolerating regular diet.

Conclusion

Large trichobezoars traditionally are removed via large anterior gastrotomy. The use of hydrodissection with warm irrigation can soften the bezoar and make it more pliable for removal through a smaller gastrotomy and minimize iatrogenic mucosal damage.

Journal Title

Journal of Pediatric Surgery Case Reports

Volume

114

First Page

102954

Keywords

Case report; Gastric trichobezoar; Gastrointestinal obstruction; Trichotillomania; Refeeding syndrome

Comments

This article is available under the Creative Commons CC-BY-NC-ND license and permits non-commercial use of the work as published, without adaptation or alteration provided the work is fully attributed.

Publisher's Link: https://www.sciencedirect.com/science/article/pii/S2213576624001829?via%3Dihub

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