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Rare gastric bezoar in a school-aged child: a paediatric diagnostic conundrum
Mercy Buabeng Asamoah1, Zoha Alam2, Mohammed Alam2
1Paediatrics and Neonatology, Newham University Hospital, Barts Health NHS Trust, London, England, UK mercy.asamoah@nhs.net.
Insights
A rare pediatric trichobezoar, a hairball in the stomach, caused a delayed diagnosis of abdominal mass and pain. Early suspicion and advanced imaging are crucial for timely intervention and successful surgical removal.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Diagnostic Imaging
Background:
- A healthy toddler initially presented with constipation, treated with laxatives.
- Four years later, the patient developed an abdominal mass and pain, with normal routine lab tests.
Purpose of the Study:
- To report a case of a large gastric trichobezoar in a pediatric patient.
- To highlight the diagnostic challenges and management strategies for bezoars.
Main Methods:
- Ultrasound revealed a thickened hyperechoic wall with acoustic shadowing and enlarged mesenteric lymph nodes.
- CT scan suggested a bezoar, followed by MRI confirming a trichobezoar.
- Surgical exploration and removal of the gastric trichobezoar.
Main Results:
- A large trichobezoar was successfully removed from the stomach.
- The patient recovered well postoperatively.
- The case underscores the importance of considering bezoars in pediatric abdominal masses.
Conclusions:
- Early suspicion of bezoars is vital in pediatric patients with persistent gastrointestinal symptoms.
- Advanced imaging techniques like CT and MRI are essential for accurate diagnosis.
- A multidisciplinary approach involving surgery and diagnostics improves patient outcomes for trichobezoars.
Abstract:
A healthy toddler presented with a 1-month history of constipation and was started on laxatives. Four years later, the patient returned with an abdominal mass and pain, but no vomiting, diarrhoea or hard stools. An ultrasound showed a thickened hyperechoic wall with acoustic shadowing in the epigastric region and enlarged mesenteric lymph nodes. Routine laboratory tests were normal. Laxatives were reintroduced, and a follow-up ultrasound 3 months later still indicated an abdominal mass. Five months afterwards, the CT scan suggested a bezoar, leading to a referral to the paediatric surgical unit. A month later, an MRI scan strongly suggested a trichobezoar. Surgery was performed 4 months later, revealing a large trichobezoar in the stomach. The patient has been well postoperation. We outline the epidemiology, key investigations and management options for these lesions. Furthermore, this report emphasises the importance of early suspicions of bezoars, advanced imaging techniques and a multidisciplinary approach in management.
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