Paediatric Surgery (Ukraine). 2024. 4(85): 136-142. doi: 10.15574/PS.2024.4(85).136142
Pereyaslov A. A.¹, Stenyk R. V.², Mykyta M. M.², Malovanyy B. Y.², Nykyforuk O. M.^1,2, Hyzha L. Y.¹,. Dats R. I ^1
1Danylo Halytsky Lviv National Medical University, Ukraine
²CNE of Lviv Regional Council Clinical Center of Pediatric Medicine Hospital «OKHMATDYT», Ukraine

For citation: Pereyaslov AA, Stenyk RV, Mykyta MM, Malovanyy BY, Nykyforuk OM, Hyzha LY, Dats RI. (2024). Bezoars of gastro-intestinal tract in children. Paediatric Surgery (Ukraine). 4(85): 136-142. doi: 10.15574/PS.2024.4(85).136142.
Article received: Aug 26, 2024. Accepted for publication: Dec 10, 2024.

Bezoars are indigestible substances that accumulated in the lumen of digestive canal. Among various types of bezoars, trichobezoar is the most frequent form, which revealed in stomach and often associated with psychiatric disorders. Rapunzel syndrome is a rare form of bezoar that included the presence of bezoar in stomach that extending through the pylorus, with the potential to extend up to the cecum. Due to the relatively rarity of this entity, there are no generally established guidelines for its diagnostic and management.
Аim – summarizing the own experience of the treating children with bezoars, including with Rapunzel syndrome.
Clinical cases. Five patients (4 girls and one boy) that were treated at Lviv reginal children’s clinical hospital «OHMATDYT» for 1997-2024 years were included in this study. Pain syndrome and presence of palpable mass at the upper parts of abdomen was noted in all patients, by that the weight loss was revealed only in one patient. Four patients were hospitalized for the emergent condition – signs of intestinal obstruction. For the diagnosis establishment, the endoscopy was applied in two patients, ultrasonography – in two patients, and computed tomography – in one patient. All patients were operated with the applying of laparotomic approach: in three patients were revealed trichobezoar, including two cases of Rapunzel syndrome, in one patient bezoar consisted of a cluster of chewing gum, and in one patient – undigested pieces of cotton tissue, which were not only in the stomach, but also in the small intestine. Endoscopy and computed tomography are the main instrumental methods for the confirmation of bezoar diagnosis. The endoscopic or laparoscopic removing of bezoar can be applied in selected patients, but the main method of treatment is open surgery. The consultation and treatment of psychiatric is required at the follow-up.
Conclusions. Clinical course of bezoars during long time may be asymptomatic, by that the main clinical appearance are the pain or discomfort in epigastric region and the presence of the dense mass at the projection of stomach.
The research was carried out in accordance with the principles of the Declaration of Helsinki. Informed consent of the patients was obtained for the research.
No conflict of interests was declared by the authors.
Keywords: children, bezoar, Rapunzel syndrome, diagnostic, treatment.

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