AN INTRALUMINAL SURGICAL APPROACH TO THE MANAGEMENT OF GASTRIC BEZOARS

Trichobezoars are difficult to remove endoscopically, often cause naus ea and vomiting, and can result in small-bower obstruction. A patient with a trichobezoar presented to our clinic with symptoms of partial s mall-bowel obstruction. Multiple attempts at flexible endoscopic remov al were unsuccessful. Two large-diameter percutaneous gastrostomies wi th an inflatable balloon and distal foam-rubber stent to assure intrag astric positioning were introduced under general anesthesia. Visualiza tion was provided by a 0 degrees panavision laparoscope placed through one of the gastrostomies. The bezoar was removed through the second g astrostomy using standard laparoscopic instruments. The patient made a n uneventful recovery. This is the first reported case of percutaneous removal of a trichobezoar. We conclude large-diameter gastrostomies m ay serve as a port of access for numerous other intraluminal procedure s.