Giant Chronic Gastric Trichobezoar: Total Gastrectomy

Journal Full Title: Journal of Biomedical Research & Environmental Sciences Journal NLM Abbreviation: J Biomed Res Environ Sci Journal Website Link: https://www.jelsciences.com Journal ISSN: 2766-2276 Category: Multidisciplinary Subject Areas: Medicine Group, Biology Group, General, Environmental Sciences Topics Summation: 133 Issue Regularity: Monthly Review Process: Double Blind Time to Publication: 21 Days Indexing catalog: IndexCopernicus ICV 2022: 88.03 | GoogleScholar | View more Publication fee catalog: Visit here DOI: 10.37871 (CrossRef) Plagiarism detection software: iThenticate Managing entity: USA Language: English Research work collecting capability: Worldwide Organized by: SciRes Literature LLC License: Open Access by Journal of Biomedical Research & Environmental Sciences is licensed under a Creative Commons Attribution 4.0 International License. Based on a work at SciRes Literature LLC. Manuscript should be submitted in Word Document (.doc or .docx) through Online Submission form or can be mailed to [email protected] BIBLIOgRAPhIC INFORMATION SySTEM Vision: Journal of Biomedical Research & Environmental Sciences main aim is to enhance the importance of science and technology to the scientific community and also to provide an equal opportunity to seek and share ideas to all our researchers and scientists without any barriers to develop their career and helping in their development of discovering the world. IndexCopernicus ICV 2022: 83.03 CASE STUDY Giant Chronic Gastric Trichobezoar: Total Gastrectomy Eduardo Domínguez-Adame1,2*, Cristina Hurtado1 and Marta Domínguez1 1Department of General and Digestive Surgery, Virgen Macarena University Hospital, Spain 2Faculty of Medicine, University of Seville, Spain *Corresponding author(s) Eduardo Domínguez-Adame, Department of General and Digestive Surgery, Virgen Macarena University Hospital, Spain ORCID ID: 0000-0002-0116-9663 Email: [email protected] DOI: 10.37871/jbres2107 Submitted: 19 May 2025 Accepted: 22 May 2025 Published: 23 May 2025 Copyright: © 2025 Domínguez-Adame E, et al Distributed under Creative Commons CC-BY 4.0 OPEN ACCESS VOLUME: 6 ISSUE: 5 - MAY, 2025 GASTROENTEROLOGY SURGERY How to cite this article: Domínguez-Adame E, Hurtado C, Domínguez M. Giant Chronic Gastric Trichobezoar: Total Gastrectomy. J Biomed Res Environ Sci. 2025 May 23; 6(5): 530-531. doi: 10.37871/jbres2107, Article ID: JBRES2107, Available at: https://www. jelsciences.com/articles/jbres2107.pdf Introduction 22-year-old patient (height 184 cm, weight 53 kg, Body Mass Index 15.65 kg/m2) with a previous history of trichophagia (Rapunzel Syndrome) in adolescence. For 1 year, he has had intermittent, stabbing epigastric discomfort of variable duration, unrelated to food intake and accompanied by hyporexia, nausea without vomiting, premature satiety and unquantifi ed weight loss. He has a painless palpable tumor in the epigastrium. Endoscopy (Figure 1): megadilated stomach with a giant stony, calcifi ed trichobezoar, not amenable to endoscopic treatment. Abdomino-pelvic CT scan (Figure 2): stomach enlargement, reaching 250 mm longitudinally, extending over the void and right iliac fossa, not ruling out that they correspond to food remains/foreign body. She was referred for surgery (Figure 3) where a megastomach was found due to a giant, calcifi ed, impacted stony trichobezoar. Since the gastric trichobezoar was stony and occupied the entire gastric cavity, it was not possible to fragment it with the endoscope. Therefore, surgery was decided due to the food starvation of the patient. A total gastrectomy was performed with a Roux-en-Y loop gastrojejunal anastomosis (Billroth III technique). The postoperative course was favorable, and the patient was discharged from the hospital on the fourth day without incident. Six months after surgery, the patient is doing well, has regained weight, and has been discharged for clinical follow-up by the Surgery Department. Figure 1 Endoscopic image of a giant gastric trichobezoar. (A) Trichobezoar imprint in the cardia. (B) Stony, calcifi ed gastric trichobezoar that prevents progression of the endoscope in the gastric cavity. Domínguez-Adame E, et al. (2025) J Biomed Res Environ Sci, DOI: https://dx.doi.org/10.37871/jbres2107 531 Discussion Gastric trichobezoars can become large and extend into the small intestine (Rapunzel syndrome). Their diagnosis is completed with imaging studies such as ultrasound, CT scans, and endoscopies. Treatment is based on the removal of the trichobezoar, either endoscopically or surgically. Sometimes, due to its size, impaction, and time of evolution, it will be necessary to perform an excisional surgery (gastrectomy) due to the gastric atony caused by the trichobezoar [1-3]. Figure 2 CT scan giant gastric trichobezoar. (A) Coronal image. (B) Axial image. (C) Sagittal image. Figure 3 Total gastrectomy for giant gastric trichobezoar. (A) Stomach almost completely occupied. (B) Stony, calcifi ed and impacted gastric trichobezoar. References 1. Paschos KA, Chatzigeorgiadis A. Pathophysiological and clinical aspects of the diagnosis and treatment of bezoars. Ann Gastroenterol. 2019;32(3):224-232. doi: 10.20524/ aog.2019.0370. 2. Khalifa MB, Ghannouchi M, Nacef K. Trichobezoar: A case report of a double gastric and ilial localization revealed by an occlusion. Int J Surg Case Rep 2022;91:106782. doi: 10.1016/j. ijscr.2022.106782. 3. Luisa Paola GH, Isabel MO, Ernesto MS, Elena MC. Duodenal diastatic perforation due to double gastric and jejunal trichobezoar in a patient with Rapunzel syndrome. Rev Esp Enferm Dig. 2023;115(4):222-223. doi: 10.17235/reed.2023.9394/2022.