Simplified technique for retrieval of large trichobezoars in children

Trichobezoars are concentrations of indigestible hair or hair-like fibres within the proximal intestinal tract. In children, delayed presentation with large bezoar masses is not unusual as bezoar formation is an indolent process that takes many months or years before becoming symptomatic. Surgical m...

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Bibliographic Details
Published in:BMJ case reports 2015-05, Vol.2015, p.bcr2015210472
Main Authors: Cundy, Thomas P, Brownlee, Ewan M, Goh, Day Way, Khurana, Sanjeev
Format: Article
Language:English
Subjects:
Abdomen
Australasia
Bezoars - surgery
Child, Preschool
Female
Gastrostomy - instrumentation
Gastrostomy - methods
Humans
Laparotomy - instrumentation
Laparotomy - methods
Novel Treatment (New Drug/Intervention
Established Drug/Procedure in New Situation)
Ostomy
Stomach
Stomach - surgery
White
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Summary:Trichobezoars are concentrations of indigestible hair or hair-like fibres within the proximal intestinal tract. In children, delayed presentation with large bezoar masses is not unusual as bezoar formation is an indolent process that takes many months or years before becoming symptomatic. Surgical management is challenging and becomes inevitable once a trichobezoar becomes more established. The standard approach involves a sizeable transverse or midline laparotomy. We describe a less invasive technique for extraction of large gastric trichobezoars via a mini-laparotomy. The key aspect to this technique involves insertion of an Alexis O Wound Protector/Retractor (Applied Medical, Rancho Santa Margarita, California, USA) into the stomach following creation of a secure temporary gastrostomy by hitching gastrotomy edges to the abdominal wall. This simplified approach has advantages of (1) secure and excellent direct intragastric access, (2) shorter operating time and (3) reliable protection of both the wound edges and peritoneal cavity from bezoar contamination.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2015-210472