Laparoscopic removal of intragastric trichobezoar in a child: A case report

Introduction: A trichobezoar is a mass of indigestible hair in the gastrointestinal tract caused by hair ingestion, usually associated with trichotillomania and trichophagia. Although sometimes asymptomatic, it can become a rare cause of intestinal obstruction and require an emergent surgical intervention. The operative approach of choice, laparotomy versus laparoscopy, is still controversial.Case presentation: A 11-year-old girl was admitted to our institution with abdominal pain, vomiting and anorexia for 3 days. On abdominal examination, she had diffused abdominal pain with tenderness in the mesogastrium, with no palpable mass. Abdominal computed tomography (CT) scan and barium meal study shown a large gastric mass. Upper gastrointestinal (GI) endoscopy identified an enormous trichobezoar, which was later removed laparoscopically. An anterior gastrotomy was performed and the bezoar was then transferred en bloc into the endo-bag. The neck of the endobag was then exteriorized through the umbilical incision and removed by gradual fragmentation. The volume and size of the phytobezoars were 1875 cm3 and 25 x 15 x 5 cm. The patient was discharged on the 5th postoperative day without any complications. Conclusion: Successful laparoscopic management of pediatric trichobezoar may be accomplished by a 4-ports approach. It allows a lower intraoperative risk of contaminations, a rapid recovery and good cosmetic results in children.