Download Laparoscopic Retrieval of a Large Gastric Phytobezoar

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LAPAROSCOPIC RETRIEVAL OF A LARGE GASTRIC
PHYTOBEZOAR
O. Avrutis1, O. Sibirsky1, E. Tzvang3, J. Meshoulam1, L. Haskel2, A. Durst1
Department of Surgery1 and Radiology2, Bikur Cholim Hospital, Jerusalem
Unit of Gastroenterology3, Hadassah University Hospital, Jerusalem
Background: Allowedly, small gastric bezoars might be evacuate
endoscopically or managed by enzymatic dissolution. Large and hard
bezoars traditionally are removed at laparotomy. The laparoscopic
approach, however, provides a minimally invasive alternative to manage
this pathology without the necessity of a large incision.
Case description: A 42-year-old woman presented in outpatient clinic with
epigastric pain and fullness, heartburn, intermittent vomiting, and weight
loss up to 10 kg of 3 months duration. She had not taken any medication and
had not undergone any abdominal surgery. Gastroscopy showed a large
solid bezoar in the fundus of the stomach. In order to soften the bezoar the
patient had received Papase (60.000U/ day) during one month, but
attempted endoscopic removal was unsuccessful. She was referred to our
department. Clinical examination was unremarkable. Upper GI series
detected large 6x6x7cm mobile bezoar. Gastric motility and emptying and
the small bowel passage seemed to be normal. Laparoscopic retrieval was
undertaken using four trocars. The solid bezoar was extracted via a
gastrotomy in the body of the stomach. The gastrotomy was closed with two
layers of intracorporeal continuous Vicryl 3/0 sutures. The bezoar was
retrieved inside the Endo-Bag through enlarged 12-mm port wound. The
procedure took 85 minutes. The recovery was uneventful. We think that
laparoscopic management of large gastric bezoar might be recommend
when laparotomy is indicated.