Successful Endoscopic Removal of a Large Gastric Trichobezoar Causing Gastric Outlet Obstruction in a Female Child

Abstract

Bezoar carries a real challenge in its management. Due to lack of suspicion, diagnosis can be delayed until reaching a huge size or presenting by obstructive manifestations. Trichobezoars are the most difficult to treat with most of cases necessitating surgical intervention.Here we present a four-year old female child with a huge gastric trichobezoar. Diagnosis was missed for one month till presenting with gastric outlet obstruction. Upper gastrointestinal endoscopy revealed a huge trichobezoar impacted in the pyloric ring. Initial endoscopic trials of its release from the pylorus were failing. Careful defragmentation using a foreign body forceps was finally successful to remove the whole bezoar, piece by piece, in one endoscopic session. In spite difficult, patient endoscopic approach can be the first modality for removal of large sized gastric trichobezoars.

Trichobezoar: A Rare Cause of Protein-losing Enteropathy

“…Retrieval may need multiple endoscopic passes and a prolonged procedure time of up to 5 hrs. We have summarized case reports (Table 2) that have described the successful removal of trichobezoar endoscopically (14–23). These case reports are, however, outnumbered by cases reported where endoscopic removal was unsuccessful.…”