Point-of-care gastric ultrasound in trichobezoar: case report
Trichobezoar is a rare entity that consists of a mass of hair particles in the gastrointestinal tract. The treatment of trichobezoar is basically surgical; however, alterations in gastric emptying represent a challenge for anesthesia because of the risk of bronchoaspiration during induction. Ultrasonography as a perioperative tool is helpful to guide decision-making and to plan the anesthetic technique to evaluate the gastric contents.
Clinical findings, diagnostic evaluation, and interventions:
This is a case of an emergent surgical correction due to trichobezoar. The ultrasound findings of the gastric evaluation allowed for the identification of a patient at risk of regurgitation and guided the decision about the induction of anesthesia.
Currently, the opinion of the anesthesiologist based on the medical record and the physical examination determines the approach to the induction of anesthesia. The qualitative evaluation of the gastric contents using ultrasound, in addition to the physical examination, is extremely useful in case of a surgical emergency or in the absence of more sophisticated diagnostic images, when suspecting conditions with a full stomach and high risk of bronchoaspiration.
2. Hall J, Shami V. Rapunzel’s syndrome: gastric bezoars and endoscopic management. Gastrointest Endosc Clin N Am 2006; 16:111-119.
3. England R, Patel R, Marven S. Laparoscopic management of primary intestinal trichobezoar. J Pediatr Surg Case Rep 2013; 1:108110.
4. Tudor E, Clark M. Laparoscopic-assisted removal of gastric trichobezoar; a novel technique to reduce operative complications and time. J Pediatr Surg 2013; 48:13-15.
5. Dave N, Karnik P, Garasia M. Large gastric wood bezoar: anesthesia implications. J Anaesthesiol Clin Pharmacol 2016; 32:400.
6. Iwamuro M, Okada H, Matsueda K, et al. Review of the diagnosis and management of gastrointestinal bezoars. World J Gastrointest Endosc 2015; 7:336-345.
7. Wolski M, Gawlowska-Sawosz M, Gogolewski M, et al. Trichotillomania, trichophagia, trichobezoar-summary of 3 cases. Endo-scopic follow up scheme in trichotillomania. Psychiatr Pol 2016; 50:145-152.
8. American Society of Anesthesiologists Committee. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration. Anesthesiology 2017; 126:376-393.
9. Van de Putte Perlas A. Ultrasound assessment of gastric content and volume. Br J Anaesth 2014; 113:12-22.
10. Benhamou D. Ultrasound assessment of gastric contents in the perioperative period: why is this not part of our daily practice? Br J Anaesth 2014; 114:545-548.
11. Cubillos J, Tse C, Chan V, et al. Bedside ultrasound assessment of gastric content: an observational study. CJA 2012; 59:416-423.
12. Arzola C, Carvalho J, Cubillos J, et al. Anesthesiologists’ learning curves for bedside qualitative ultrasound assessment of gastric content: a cohort study. CJA 2013; 60:771-779.
13. Perlas A, Chan V, Lupu C, et al. Ultrasound assessment of gastric content and volume. Anesthesiology 2009; 111:82-89.
The Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.) is the owner of all copyrights to any articles published in the journal. Published manuscripts become the permanent property of S.C.A.R.E. and may not be published elsewhere without written permission. S.C.A.R.E. keeps the right to use these manuscripts in any form, including print, video, audio and digital.
Creative Commons License
Open-access articles can be read, downloaded and shared on a free basis upon publication. The Journal publishes all articles under the CCBY- NC-ND license. Attribution-NonCommercial-NoDerivs: CC BY- NC-ND. Of the six main licenses, this is the most restrictive because it only allows others to download and share articles as long as they give credit to the author, but they cannot in any way change the paper or use it commercially.