# Minimally invasive surgery for intragastric trichobezoar in pediatrics: A case report

## TL;DR

A 4-year-old girl with a large stomach hair mass was successfully treated with minimally invasive surgery, showing faster recovery and less pain than traditional methods.

## Contribution

This case demonstrates the effectiveness of laparoscopic surgery for removing large trichobezoars in children.

## Key findings

- Laparoscopic removal of a giant trichobezoar was safe and effective in a pediatric patient.
- The procedure resulted in rapid recovery, minimal pain, and good cosmetic outcomes.
- The four-port technique with an endo bag minimized peritoneal contamination risks.

## Abstract

Bezoars are indigestible masses that accumulate in the gastrointestinal tract, with trichobezoars specifically resulting from the ingestion of hair. These masses are most commonly observed in children with psychiatric conditions such as trichotillomania and trichophagia. Symptoms include abdominal pain, vomiting, constipation, and anorexia, with complications ranging from gastric ulcers to obstruction or perforation. Surgical removal is the definitive treatment, and minimally invasive techniques offer advantages over traditional open surgery.

We report the case of a 4-year-old girl with a history of ingesting hair, plastic toys, and cat hair. She presented with vomiting, constipation, anorexia, and abdominal pain but did not experience weight loss or early satiety. Physical examination revealed a palpable upper abdominal mass, and laboratory results were normal. Endoscopic retrieval of the bezoar was attempted but unsuccessful. Given the lack of signs of bowel obstruction, a computed tomography (CT) scan was not performed. The patient underwent laparoscopic evaluation of the small bowel, followed by removal of the bezoar.

The laparoscopic removal of the giant trichobezoar in this pediatric patient was successful. The procedure was safe, effective, and resulted in rapid recovery, minimal postoperative discomfort, and excellent cosmetic outcomes. In this case, the minimally invasive approach provided advantages over traditional open surgery, including reduced recovery time and less postoperative pain.

Laparoscopic surgery should be considered a viable alternative to open surgery for the removal of trichobezoars in pediatric patients. The technique is safe, effective, and offers a favorable outcome when performed in appropriately selected cases.

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•Minimally invasive laparoscopic approach for the removal of a giant gastric trichobezoar in a pediatric patient, showcasing the safety and efficacy of this technique.•Successful management of a 4-year-old girl with a history of trichophagia, presenting with abdominal pain, vomiting, anorexia, and constipation.•Four-port laparoscopic technique utilizing an endo bag to ensure controlled removal and minimize peritoneal contamination, avoiding the risks associated with open surgery.•Postoperative outcomes demonstrating minimal pain, rapid recovery, and an excellent cosmetic result, highlighting the advantages of minimally invasive surgery.•Clinical implication of laparoscopic intervention as a preferred method for the surgical treatment of large trichobezoars in pediatric patients, compared to traditional open surgery.

Minimally invasive laparoscopic approach for the removal of a giant gastric trichobezoar in a pediatric patient, showcasing the safety and efficacy of this technique.

Successful management of a 4-year-old girl with a history of trichophagia, presenting with abdominal pain, vomiting, anorexia, and constipation.

Four-port laparoscopic technique utilizing an endo bag to ensure controlled removal and minimize peritoneal contamination, avoiding the risks associated with open surgery.

Postoperative outcomes demonstrating minimal pain, rapid recovery, and an excellent cosmetic result, highlighting the advantages of minimally invasive surgery.

Clinical implication of laparoscopic intervention as a preferred method for the surgical treatment of large trichobezoars in pediatric patients, compared to traditional open surgery.