Page 54 - World Journal of Laparoscopic Surgery

Jignesh Gandhi et al

A B
Figs 1A and B: Computed tomography findings suggestive of foreign body in the stomach extending up
to the second part of duodenum

Fig. 2: Placement of ports as seen postoperatively Fig. 3: Specimen as seen postlaparoscopic removal

colon to have a control on the duodenum so as to prevent removed on postoperative day 2 without significant drain
the migration of the distal part. output. The patient was discharged uneventfully on the
Further, lubricating jelly was pushed between the 4th postoperative day.
space intervening the pyloroduodenal bezoar and the
pyloric ring to aid an easy traction on the trichobezoar, DISCUSSION
and intravenous administration of injection hyoscimine Rapunzel syndrome, as seen in this case, occurs in young
helped to dilate the pyloric ring. These steps along with females suffering from psychiatric disorders. Large
1-3
the gradual push and pull technique helped in extracting gastric bezoars may result in numerous complications –
the distal portion of the bezoar, as shown in Figure 3. most commonly intestinal obstruction, failure to thrive,
The entire specimen was placed in a previously placed and iron deficiency anemia. 4
large-size retrieval bag, and it was removed from the Although nonsurgical interventions exist, includ-
12 mm port without any contamination of the port. The ing NG lavage or suction, prokinetic agents, enzymatic
size of the entire trichobezoar was around 20 × 8 cm. fragmentation, and endoscopic retrieval, they are often
The gastrostomy was closed with laparoscopic unsuccessful in treating large trichobezoars that cause
stapler and a nasogastric (NG) tube was placed for obstructive symptoms, and therefore, surgery is required.
5
decompression. The standard surgical approach consists of open gastros-
tomy via an upper abdominal laparotomy. This proce-
POSTOPERATIVE COURSE
dure leaves patients with a large abdominal incision and
Postoperatively, the NG tube was removed after 24 hours, increased propensity to develop wound complications.
and the patient started on liquid diet which was further The first successful laparoscopic removal of a gas-
4
supplemented with soft diet after 2 days. Drain was tric bezoar was reported in 1998 by Nirasawa et al.
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