A Case of Trichobezoar in which Double Wound Retractor Placement was Useful

Abstract

An 18-year-old woman presented complaining of abdominal pain, vomiting, and an abdominal mass. Blood tests showed anemia (hemoglobin 7.7 g/dL). Abdominal computed tomography showed a massive heterogeneous, air-containing mass in the stomach and an ulcerative lesion on the lesser curvature side of the gastric angle. A massive hairball in the stomach was observed on upper gastrointestinal endoscopy. Endoscopic removal proved difficult, and it was decided to perform surgical removal with a preoperative diagnosis of trichobezoar and gastric ulcer. A small wound retractor was placed in the umbilicus, and an extra-small wound retractor was inserted through this into the stomach. This double wound retractor placement enabled the trichobezoar to be removed by a combination of intragastric and laparoscopic surgery. Previously, this operation would usually have been performed by open surgery via large laparotomy and gastrotomy, but in recent years, a few cases of intragastric surgery via a minimal surgical wound using wound retractors have been reported, although these also included reports of wound infection. This is the first reported case of the use of double wound retractor placement for a trichobezoar in Japan, and since this technique is useful for preventing wound infection and intra-abdominal abscess formation, this case is presented together with a discussion of the literature.