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A trichobezoar is a ball of swallowed hair that accumulates in the stomach and fails to pass through the intestines. Usually a trichobezoar presents in early satiety and malnutrition. Obstructive symptoms and manifestations of gastric outlet obstruction may occur. While small gastric trichobezoars may be removed via gastroscopy, large trichobezoars require surgical removal by gastrotomy through abdominal incision. We present a case of a successful mini-laparotomy removal of a giant gastric trichobezoar in a 15-year-old girl with a history of trichophagia for a long time and marginal psychological disturbances.

Background: Hypertrophic pyloric stenosis is the most common cause of gastric outlet obstruction in infants, and classically presents at 2 to 6 weeks of age. Delayed presentation is an extremely rare occurrence after early infancy. Case report: A 14-weeks-old full term male infant presented with non-bilious vomiting, dehydration and hypocloremic metabolic alkalosis. Abdominal ultrasonography revealed tubular mass 20 mm in lenght. Because of unusual age, diagnosis was confirmed with upper gastrointestinal contrast study. Laparoscopic pyloromyotomy was performed. After surgery the child was free of symptoms, had gained weight, and was tolerating a regular diet. Message: Despite the age hypertrophic pyloric stenosis should be kept in mind in any child who presents with non-bilious vomiting.

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Objective -Massive gastrointestinal bleeding in children is rare. A Dieulafoy lesion is an uncommon condition which may lead to massive and repeated upper gastrointestinal bleeding. We report a pediatric case of gastric Dieulafoy lesion which was successfully treated surgically, after repeated unsuccessful endoscopic treatment. Case Report -A previously healthy 13-year-old boy presented with hematemesis upon admission to the hospital. He had tachycardia and mild anemia. A gastroscopy revealed erosive gastritis. During the following days, hematemesis continued to reoccur and consequently led to the development of hemorrhagic shock requiring endoscopic treatment with hemoclipping and adrenalin injection. Despite that, hematemesis continued, and it was decided to perform surgical treatment. During open surgery, a tortuous blood vessel was found, suggesting a Dieulafoy lesion. Conclusion -Although rare, a Dieulafoy lesion should be suspected when treating repeating hematemesis in children. Endoscopic treatment is recommended as first-line management, but rarely, in unclear cases, surgery proves to be a better diagnostic and therapeutic option for massive gastrointestinal bleeding.

Background and Objectives: When the human body is disabled to naturally ingest food through the mouth, enteral or parenteral nutritional support should be started. Percutaneous gastrostomy (PEG) is a flexible feeding tube that is inserted into the stomach through the abdominal wall in patients who will need long-term enteral nutrient intake. The aim of this study is to analyze clinical characteristic of children at the time of PEG placement as well as to determine indications, complications and outcomes associated with PEG at the Department of Pediatrics of the University Hospital of Split. Materials and Methods: Retrospective analysis of the medical records of patients treated from 2010 to 2020 was performed. The following data were collected from medical records: age, gender, information about nasogastric feeding before PEG placement, indication for PEG insertion, duration of PEG, procedure-related complications and treatment outcomes. Malnutrition was determined according to the z-score range for BMI for age and sex. According to the indication for PEG placement, patients were divided into five categories: central nervous system (CNS) diseases, neuromuscular diseases, genetic disorders, metabolic diseases, and group of children with polytrauma. Results: A total of 40 patients with median age of 110 months were included in study. At the time of PEG placement, most patients had deviations in body weight and height compared to expected values for age and sex. The most common underlying diagnoses were diseases of the central nervous system. Minor complications were found in 13 (35%) of patients. One patient (2.7%) developed major complication (gastrocolic fistula) and consequently underwent reoperation. The median duration of PEG in patients with complications before the need for replacement was 27 months, and in patients without complications, 43 months. Conclusions: Negative deviations of z-score body weight, body height, and body mass index could indicate the need for possible earlier placement of PEG. PEG can be considered as a safe therapeutic option in children since PEG-related complications, mostly in minor forms, were found in a small number of patients.

ConclusionConsidering the nonspecific symptoms of the disease that greatly correlate with functional difficulties the number of negative findings is not surprising. But since gastroscopy is the most sensitive method of confirmation/ exclusion of the disease itself it is clear that a high number of negative findings point to the necessity of developing clearer guidelines to avoid unnecessary endoscopies. Furthermore, comparing our results with the results of similar foreign studies we can say that we are within the world average and that this indeed is a global problem that requires team effort especially at a time when the number of endoscopic procedures grows rapidly every day due to increased endoscopic possibilities.