Case Report: Endoscopic removal of a giant complex gastric trichobezoar: an alternative strategy using combined...

Giant gastric trichobezoar is a rare foreign body resulting from chronic hair ingestion and may lead to serious complications, including obstruction, perforation, and malnutrition. Conventional endoscopic removal often fails due to its large size, smooth, elastic surface, and tensile strength. Therefore, surgery is often the standard treatment. In this report, we discuss the case of a girl with a giant trichobezoar containing cotton threads, which was successfully removed following forceps-assisted mechanical fragmentation and transparent cap-assisted extraction.

A 7-year-old girl with a 5-year history of trichophagia presented with abdominal pain, distension, palpable mass, and iron-deficiency anemia. Imaging and endoscopy revealed a 12 cm × 6 cm gastric trichobezoar. As surgery was declined, endoscopic removal under general anesthesia was performed. The procedure used high-power electrocoagulation (EndoCut/Forced Coag mode) to segment the dense bezoar, followed by piecemeal extraction with forceps and cap-assisted removal to prevent cardia laceration and esophageal injury. The trichobezoar was successfully removed without mucosal injury, and the patient was discharged 4 days after the endoscopic procedure with complete resolution of symptoms.

With strict patient selection, multidisciplinary teamwork, and adequate expertise and equipment, endoscopic treatment may offer a minimally invasive alternative to the surgical removal of giant gastric trichobezoars in selected pediatric cases. Psychological support is also important to address underlying behavioral factors that may lead to recurrence.