Snapshot in surgery: How do you approach this 12‐year‐old girl?

Key Clinical Message

This case open questions about the dimensional limit for a laparoscopic treatment of a giant bezoar. A minimally invasive option should be considered every time a gastric obstruction is suspected, particularly for psychiatric patients, for whom a short hospital stay can be greatly beneficial.

1. QUESTION

How do you approach this 12‐year‐old girl with nausea and vomiting?

2. ANSWER

This young lady affected by trichotillomania presented with nausea and vomiting and a CT scan was obtained (Figure 1). Small bezoars are routinely removed endoscopically. In case of huge bezoars, open surgery is the gold standard, but a laparoscopic approach can be attempted.

Figure 1.

Abdominal CT scan showing distended stomach occupied by bezoar and picture of the specimen

In this case, after the pneumoperitoneum was achieved and ports were placed, the gastrotomy was performed with Ligasure^™ and the bezoar was taken out. The stomach was then closed. The bezoar was placed on an endobag and removed from the abdominal cavity via a 5 cm Pfannenstiel incision, covered by a wound protector. Postoperative course was uneventful and patient was discharged on postoperatory day 3. At the last follow‐up, 2 months later, the patient was asymptomatic.

CONFLICT OF INTEREST

None declared.

AUTHORSHIP

RB: drafted the article and data and images collection. FG: participated in the design of the work and critical revision. MM: performed surgery during the case, critical revision, and final approval.

Bustos R, Gheza F, Masrur M. Snapshot in surgery: How do you approach this 12‐year‐old girl?. Clin Case Rep. 2018;6:1389–1390. https://doi.org/10.1002/ccr3.1614