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Management of Complicated Gastric Bezoars in Children and Adolescents
Insights
Gastric bezoars in children, often trichobezoars, require surgical intervention when complicated. Surgery, particularly laparotomy and gastrotomy, offers an excellent outcome for these rare pediatric cases.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Diagnostic Imaging
Background:
- Gastric bezoars are rare in children, with trichobezoars being the most common type.
- Surgical intervention is sometimes necessary for complicated gastric bezoars.
Observation:
- A retrospective review of seven pediatric patients who underwent surgery for gastric bezoars between 2000 and 2010.
- Patients were females aged 4-19 years, presenting with symptoms like abdominal pain, vomiting, weight loss, and halitosis.
Findings:
- Six patients had trichobezoars, and one had a latex glove bezoar.
- Imaging modalities aided diagnosis, but endoscopic and laparoscopic attempts at removal failed in most cases.
- All patients ultimately required laparotomy with gastrotomy for successful bezoar removal.
Implications:
- Gastric bezoars should be suspected in children with unexplained gastrointestinal symptoms and abdominal masses.
- While endoscopic removal can be attempted, surgical intervention, specifically laparotomy and gastrotomy, is often necessary and yields excellent outcomes.
Background:
Gastric bezoars in children are infrequent. Most are trichobezoars. Surgical intervention is sometimes necessary.
Objectives:
To describe the clinical findings and radiological workup, as well as treatment and outcome of patients with complicated gastric bezoars who underwent surgery in our institution.
Methods:
We conducted a retrospective review of all cases of surgery for gastric bezoars performed in our institution between 2000 and 2010. Data collected included gender and age of the patients, composition and extent of the bezoar, presenting signs and symptoms, imaging studies used, performance of endoscopy, and surgical approach. Outcome was measured by the presence of postoperative complications.
Results:
We identified seven patients with gastric bezoars who underwent surgery. All were females aged 4-19 years. Six had trichobezoars and one had a mass composed of latex gloves. Presenting symptoms included abdominal pain, vomiting, weight loss, and halitosis. All patients had a palpable epigastric mass. A large variety of imaging modalities was used. Endoscopic removal was attempted in three patients and the laparoscopic approach in one patient, but both routes failed. All patients eventually underwent laparotomy with gastrotomy and recovered without complications.
Conclusions:
The presence of gastric bezoars should be suspected in any child with unexplained abdominal pain, vomiting, weight loss, or halitosis, or with a palpable abdominal mass, especially in girls. A variety of imaging modalities can aid in diagnosis. Endoscopic removal might be attempted, although failure of this approach is frequent, necessitating surgical intervention, preferably laparotomy and gastrotomy, which has an excellent outcome.
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