Combined endoscopic and laparoscopic trichobezoar extraction in a child: a case report

Bezoars are a rare pathology, with reported incidence from 0.4% to 0.7% in all ages and limited literature in the pediatric population. A 6-year-old female with no significant medical or surgical history presented to the gastroenterology clinic with abdominal pain and underwent workup including laboratory studies, fecal calprotectin, magnetic resonance imaging and endoscopy/colonoscopy. Imaging showed a large stool burden in the colon without evidence of inflammatory bowel disease. Endoscopy and colonoscopy were notable for ileitis, reactive gastritis and a trichobezoar in the stomach and duodenum. Endoscopic removal of the bezoar was unsuccessful. She was evaluated by surgery and scheduled for laparoscopic-assisted endoscopic bezoar retrieval. In the operating room, gastroenterology re-attempted endoscopic retrieval without success. We proceeded with a laparoscopic-assisted approach, placing a 5 mm port in the umbilicus and a 5 mm port in the left upper quadrant. The stomach was tacked to the abdominal wall at the left port, and a step trocar was placed into the stomach. The stomach was insufflated; shears and the Harmonic scalpel were used to breakdown the trichobezoar which was then removed endoscopically. A third 5 mm port in the RUQ was added to assist with closure of the gastrotomy. Postoperative day 1, the patient tolerated a regular diet and was discharged to home. At 3-month follow-up, her symptoms had resolved and she was gaining weight appropriately. A combined endoscopic-laparoscopic approach may be a safe and effective approach for the management of gastric trichobezoars in children.