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BMJ Case Reports 2015; doi:10.1136/bcr-2015-210472
  • CASE REPORT

Simplified technique for retrieval of large trichobezoars in children

  1. Sanjeev Khurana1,2
  1. 1Department of Paediatric Surgery, Women's and Children's Hospital, Adelaide, South Australia, Australia
  2. 2Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia
  1. Correspondence to Dr Thomas P Cundy, thomas.cundy{at}adelaide.edu.au
  • Accepted 6 May 2015
  • Published 24 May 2015

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.

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