title: Management of Complicated Gastric Bezoars in Children and Adolescents.
abstract: BACKGROUND
  Gastric bezoars in children are infrequent. Most are trichobezoars. Surgical intervention is sometimes necessary.
  
  
  OBJECTIVE
  To describe the clinical findings and radiological workup, as well as treatment and outcome of patients with complicated gastric bezoars who underwent surgery in our institution.
  
  
  METHODS
  We conducted a retrospective review of all cases of surgery for gastric bezoars performed in our institution between 2000 and 2010. Data collected included gender and age of the patients, composition and extent of the bezoar, presenting signs and symptoms, imaging studies used, performance of endoscopy, and surgical approach. Outcome was measured by the presence of postoperative complications.
  
  
  RESULTS
  We identified seven patients with gastric bezoars who underwent surgery. All were females aged 4-19 years. Six had trichobezoars and one had a mass composed of latex gloves. Presenting symptoms included abdominal pain, vomiting, weight loss, and halitosis. All patients had a palpable epigastric mass. A large variety of imaging modalities was used. Endoscopic removal was attempted in three patients and the laparoscopic approach in one patient, but both routes failed. All patients eventually underwent laparotomy with gastrotomy and recovered without complications.
  
  
  CONCLUSIONS
  The presence of gastric bezoars should be suspected in any child with unexplained abdominal pain, vomiting, weight loss, or halitosis, or with a palpable abdominal mass, especially in girls. A variety of imaging modalities can aid in diagnosis. Endoscopic removal might be attempted, although failure of this approach is frequent, necessitating surgical intervention, preferably laparotomy and gastrotomy, which has an excellent outcome.
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Castle
authors.forename: Osnat
authors.initials: O
authors.lastname: Zmora
authors.forename: Stephanie
authors.initials: S
authors.lastname: Papillon
authors.forename: Dan
authors.initials: D
authors.lastname: Levin
authors.forename: James E
authors.initials: JE
authors.lastname: Stein
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D000293:Adolescent; D001630:Bezoars / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D014839:Vomiting / Q000209:etiology; D055815:Young Adult