Page 53 - World Journal of Laparoscopic Surgery

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10.5005/jp-journals-10033-1283
Laparoscopic Removal of a Giant Gastroduodenal Bezoar
CaSe RepORt

Laparoscopic Removal of a Giant Gastroduodenal Bezoar

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1 Jignesh Gandhi, Saneya Pandrowala, Sadashiv Choudhari, Suryaprakash Bhandari
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ABSTRACT of surgeries are being reported to have lesser morbidity

In today’s era of laparoscopic surgery, removal of giant gastric when performed laparoscopically. We report a case of
trichobezoar laparoscopically has become a common parlance. complete laparoscopic excision of a gastroduodenal
However, removal of gastroduodenal bezoar laparoscopically bezoar en masse without a duodenal incision in a young
en masse is extremely rare. We present a case of 15-year- female which has not yet been reported.
old female with gastroduodenal bezoar, which was removed
laparoscopically without any complications, stressing on the
fact that adequate preoperative evaluation to know the extent CASE REPORT
of bezoar and good laparoscopic technique to prevent it from A 15-year-old female came with progressively increasing
breaking intraoperatively are necessary for a good outcome.
complaints of pain in abdomen and vomiting since last
Keywords: Bezoar, Gastroduodenal, Giant, Laparoscopic.
1½ years. The clinical symptoms worsened since last
How to cite this article: Gandhi J, Pandrowala S, Choudhari S, 7 days with severe abdominal pain and intractable
Bhandari S. Laparoscopic Removal of a Giant Gastroduodenal vomiting, including difficulty to swallow the saliva.
Bezoar. World J Lap Surg 2016;9(2):101-103.
She had history of loss of appetite and gradual loss
Source of support: Nil
of weight during this clinical period. She had neither
Conflict of interest: None history of fever nor any other prodromal symptoms. She
was an introvert child in the school. On further inquiry,
INTRODUCTION the mother gave a history of noticing alopecia in select
area of the scalp which was attributed to poor nutrition
Bezoars are concretions of human or vegetable fibers status.
that accumulate in the gastrointestinal tract. In humans, On examination, the patient was vitally stable with
the most common type of bezoar is the trichobezoar, pulse 82 beats per minute, blood pressure 110/70 mm Hg,
which is mostly made of hair. However, bezoars can afebrile with respiratory rate 14 cycles/minutes. On
also be made of vegetable or fruit fiber (phytobezoars), systemic examination, the patient has a large 15 × 10 cm
milk curd (lactobezoars), or any indigestible material. large lump in the epigastrium, reaching up to umbilicus
Trichobezoars, unlike other bezoars, are not associated which was firm, nontender, and moving with respiration.
with alterations in gastrointestinal motility but with Her laboratory investigations were normal except for a
underlying psychiatric disorders, and these are most low hemoglobin of 9.2 gm%. Computed tomography (CT)
commonly present in adolescents and during the second scan was asked for which showed a large-size foreign
decade of life. Rapunzel syndrome is an unusual and rare body occupying the whole of the stomach extending up
form of trichobezoar extending into the small intestine. 1 to the second part of duodenum, as shown in Figures 1A
In the era of minimal access surgery, laparoscopic
surgeries are the rule and not the exception. All kinds and B.
A clinical diagnosis of trichobezoar was made after
confirming with the mother and the child, both later
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1 Associate Professor, Postgraduate Student, Assistant confided the history of ingesting her hair on daily basis
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Professor, Consultant for last 1½ years secondary to mood disorder.
1,3 Department of General Surgery, King Edward Memorial
Hospital and Seth Gordhandas Sunderdas Medical College OPERATIVE TECHNIQUE
Mumbai, Maharashtra, India
Laparoscopic removal of this giant trichobezoar was done
2 Department of General Surgery, Seth Gordhandas Sunderdas
Medical College, Mumbai, Maharashtra, India with three port technique as shown in Figure 2.
A gastrostomy was performed in the body of the
4 Department of Gastroenterology, Global Hospitals, Mumbai
Maharashtra, India stomach after mobilizing the entire greater curvature of
the stomach, so as to facilitate the removal of the proximal
Corresponding Author: Jignesh Gandhi, Associate Professor
Department of General Surgery, King Edward Memorial portion of the trichobezoar in the region of fundus and
Hospital and Seth Gordhandas Sunderdas Medical College body of stomach. The challenge was to remove the distal
Mumbai, Maharashtra, India, Phone: +919920443433, e-mail: tail and duodenal part of the trichobezoar. This was
jigneshkem@gmail.com
facilitated by first mobilizing the hepatic flexure of the
World Journal of Laparoscopic Surgery, May-August 2016;9(2):101-103 101