{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T23:23:34Z","timestamp":1776295414682,"version":"3.50.1"},"reference-count":36,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Klin Padiatr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Trichobezoars represent a rare condition in paediatric patients, and\n                        evidence-based treatment recommendations are lacking. Most reported cases\n                        describe surgical removal, predominantly by laparotomy.<\/jats:p>\n                  <jats:p>We present a minimally invasive surgical strategy based on two paediatric\n                        cases of gastric trichobezoars and review the current literature. A PubMed\n                        search was performed including research articles and case reports published\n                        between 2016 and 2020. Inclusion criteria were isolated trichobezoars in\n                        patients aged \u226418 years, while reports describing combined bezoars were\n                        excluded. Extracted data included age, sex distribution, clinical\n                        presentation, medical history, imaging, treatment modality, and follow-up\n                        management.<\/jats:p>\n                  <jats:p>Thirty-four publications comprising 41 paediatric cases of trichobezoars were\n                        identified (age range: 2\u201317 y; female-to-male ratio: approximately 7:1).\n                        Endoscopic removal was attempted in 10 cases, requiring conversion to\n                        laparotomy in nine cases and to a modified laparoscopic technique in one\n                        case. Overall, 36 bezoars were removed by laparotomy, 5 by a modified\n                        laparoscopic technique, and only 1 by purely laparoscopic extraction without\n                        auxiliary incision.<\/jats:p>\n                  <jats:p>Our modified minimally invasive approach resulted in an uncomplicated\n                        postoperative course and a favourable cosmetic outcome. The technique\n                        enables safe removal of trichobezoars while minimising the risk of\n                        intra-abdominal contamination.<\/jats:p>","DOI":"10.1055\/a-2833-9457","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T22:35:00Z","timestamp":1776292500000},"source":"Crossref","is-referenced-by-count":0,"title":["Do Paediatric Patients with a Trichobezoar Benefit from a Modified\n                    Laparoscopic Approach? A Systematic Review"],"prefix":"10.1055","author":[{"given":"Frauke Alexandra","family":"Blaum","sequence":"additional","affiliation":[{"name":"Paediatric Surgery, St\u00e4dtisches Klinikum Braunschweig\n                    gGmbH, Brunswick, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmad","family":"Alsweed","sequence":"additional","affiliation":[{"name":"Paediatric Surgery, American Hospital Dubai, Dubai,\n                    United Arab Emirates"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wolfgang","family":"Eberl","sequence":"additional","affiliation":[{"name":"Paediatrics, St\u00e4dtisches Klinikum Braunschweig gGmbH,\n                    Brunswick, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esther","family":"Lau","sequence":"additional","affiliation":[{"name":"Paediatric Surgery, St\u00e4dtisches Klinikum Braunschweig\n                    gGmbH, Brunswick, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Leonhardt","sequence":"additional","affiliation":[{"name":"Paediatric Surgery, Christliches Kinderhospital Osnabr\u00fcck, Osnabr\u00fcck,\n                    Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1002\/ccr3.2576","article-title":"Trichobezoar as a cause of pediatric acute small bowel obstruction","volume":"8","author":"AM F Kwok","year":"2020","journal-title":"Clin Case Rep"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.ijscr.2018.01.004","article-title":"Gastric ulceration and perforation secondary to large trichobezoar\u2014A case report\n                    describing the role of magnetic resonance imaging in diagnosis","volume":"43","author":"M M Hennessy","year":"2018","journal-title":"Int J Surg Case Rep"},{"issue":"01","key":"ref3","first-page":"97","article-title":"Trichobezoar: Ravenous for hair","volume":"8","author":"A Prasad","year":"2018","journal-title":"Euroasian J Hepatogastroenterol"},{"issue":"12","key":"ref4","doi-asserted-by":"crossref","first-page":"918","DOI":"10.12998\/wjcc.v2.i12.918","article-title":"Gastric trichobezoar associated with perforated peptic ulcer and Candida\n                    glabrata infection","volume":"2","author":"H L Morales","year":"2014","journal-title":"World J Clin Cases"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"685","DOI":"10.12659\/AJCR.915517","article-title":"Fungal peritonitis with fungus balls, a complication of trichobezoars and\n                    rapunzel syndrome","volume":"20","author":"E Sotoudeh","year":"2019","journal-title":"Am J Case Rep"},{"key":"ref6","first-page":"11","article-title":"The diagnosis and treatment of Rapunzel\n                    syndrome","volume":"5","author":"Z Wang","year":"2016","journal-title":"Acta Radiol Open"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"42","DOI":"10.4103\/0972-9941.107142","article-title":"A modified minimally invasive technique for the surgical management of large\n                    trichobezoars","volume":"9","author":"A Javed","year":"2013","journal-title":"J Minim Access Surg"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1016\/j.ijscr.2018.11.030","article-title":"Best management modality of trichobezoar: A case report","volume":"53","author":"E M Al-Osail","year":"2018","journal-title":"Int J Surg Case Rep"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1093\/pch\/pxx210","article-title":"Failing to thrive, abdominal pain and vomiting: A hairy situation","volume":"23","author":"V A Au","year":"2018","journal-title":"Paediatr Child Health"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.radcr.2016.07.003","article-title":"A hairy situation: Trichobezoar presenting with intussusception, and intestinal\n                    and biliary perforation in a child","volume":"12","author":"A D Baheti","year":"2017","journal-title":"Radiol Case Rep"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1186\/s13256-018-1883-9","article-title":"Surgical outcome of jejunum-jejunum intussusception secondary to Rapunzel\n                    syndrome: A case report","volume":"12","author":"M A Bolivar-Rodriguez","year":"2018","journal-title":"J Med Case Rep"},{"issue":"07","key":"ref12","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1002\/ccr3.1614","article-title":"Snapshot in surgery: How do you approach this 12-year-old girl?","volume":"6","author":"R Bustos","year":"2018","journal-title":"Clin Case Rep"},{"issue":"02","key":"ref13","first-page":"90","article-title":"The Rapunzel syndrome. Report of a case","volume":"37","author":"P Caiazzo","year":"2016","journal-title":"G Chir"},{"issue":"01","key":"ref14","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1186\/s12887-018-1097-8","article-title":"Rapunzel syndrome: An infrequent cause of severe iron deficiency anemia and\n                    abdominal pain presenting to the pediatric emergency department","volume":"18","author":"G Cannalire","year":"2018","journal-title":"BMC Pediatr"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.ijscr.2019.04.002","article-title":"Surgical treatment of gastric outlet obstruction from a large trichobezoar: A\n                    case report","volume":"57","author":"E Chahine","year":"2019","journal-title":"Int J Surg Case Rep"},{"issue":"21","key":"ref16","doi-asserted-by":"crossref","first-page":"3649","DOI":"10.12998\/wjcc.v7.i21.3649","article-title":"Giant gastroduodenal trichobezoar: A case report","volume":"7","author":"Z H Dong","year":"2019","journal-title":"World J Clin Cases"},{"issue":"02","key":"ref17","doi-asserted-by":"crossref","first-page":"7689","DOI":"10.4081\/pr.2018.7689","article-title":"Rapunzel syndrome: How to orient the diagnosis","volume":"10","author":"E Finale","year":"2018","journal-title":"Pediatr Rep"},{"issue":"03","key":"ref18","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1159\/000492810","article-title":"Small-bowel obstruction secondary to ileal trichobezoar in a patient with\n                    rapunzel syndrome","volume":"12","author":"B E Garcia-Ram\u00edrez","year":"2018","journal-title":"Case Rep Gastroenterol"},{"issue":"07","key":"ref19","doi-asserted-by":"crossref","first-page":"660","DOI":"10.5152\/tjg.2018.18423","article-title":"How should trichobezoar be treated in children?","volume":"30","author":"F Gulerman","year":"2019","journal-title":"Turk J Gastroenterol"},{"issue":"02","key":"ref20","doi-asserted-by":"crossref","first-page":"50","DOI":"10.4103\/ijt.ijt_38_17","article-title":"Gastric trichobezoars in children: Surgical overview","volume":"9","author":"A Gupta","year":"2017","journal-title":"Int J Trichology"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"252","DOI":"10.11604\/pamj.2017.27.252.9110","article-title":"Giant gastric trichobezoar in a young female with Rapunzel syndrome: Case\n                    report","volume":"27","author":"M Hamid","year":"2017","journal-title":"Pan Afr Med J"},{"issue":"01","key":"ref22","doi-asserted-by":"crossref","first-page":"84","DOI":"10.4103\/njs.NJS_20_19","article-title":"A modified laparoscopic technique for the removal of nonfragmentable giant\n                    gastric trichobezoar","volume":"26","author":"S Harikrishnan","year":"2020","journal-title":"Niger J Surg"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.ijscr.2017.08.060","article-title":"Trichobezoar with and without Rapunzel syndrome in paediatric population: A case\n                    series from a tertiary care centre of Northern India","volume":"40","author":"P Kajal","year":"2017","journal-title":"Int J Surg Case Rep"},{"key":"ref24","first-page":"2018","article-title":"Rapunzel syndrome: A tail too long to tell!","author":"K Khanna","year":"2018","journal-title":"BMJ Case Rep"},{"issue":"22","key":"ref25","doi-asserted-by":"crossref","first-page":"e3745","DOI":"10.1097\/MD.0000000000003745","article-title":"A case report: Large trichobezoar causing rapunzel syndrome","volume":"95","author":"S C Kim","year":"2016","journal-title":"Medicine (Baltimore)"},{"key":"ref26","first-page":"7638504","article-title":"Laparoscopic management of acute pancreatitis secondary to\n                    Rapunzel syndrome","volume":"2016","author":"B Koushk Jalali","year":"2016","journal-title":"Case Rep Surg"},{"issue":"02","key":"ref27","doi-asserted-by":"crossref","first-page":"112","DOI":"10.4103\/jiaps.JIAPS_1_19","article-title":"Rapunzel syndrome in a 3-year-old boy: A menace too early to present","volume":"25","author":"M Kumar","year":"2020","journal-title":"J Indian Assoc Pediatr Surg"},{"issue":"09","key":"ref28","first-page":"TD01","article-title":"Rapunzel syndrome","volume":"11","author":"S Lalith","year":"2017","journal-title":"J Clin Diagn Res"},{"issue":"02","key":"ref29","first-page":"20180080","article-title":"Large gastric trichobezoar causing failure to thrive and iron\n                    deficiency anaemia in an adolescent girl: A case report emphasising the imaging\n                    findings and review of the literature","volume":"5","author":"D Lyons","year":"2019","journal-title":"BJR Case\n                    Rep"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.ijscr.2017.03.011","article-title":"Trichobezoar presenting as a gastric outlet obstruction: A case report","volume":"34","author":"E Nwankwo","year":"2017","journal-title":"Int J Surg Case Rep"},{"issue":"02","key":"ref31","doi-asserted-by":"crossref","first-page":"11","DOI":"10.21699\/ajcr.v8i2.549","article-title":"Ileal trichobezoar presenting as intestinal obstruction and peritonitis","volume":"8","author":"K N Rattan","year":"2017","journal-title":"APSP J Case Rep"},{"issue":"04","key":"ref32","doi-asserted-by":"crossref","first-page":"e111","DOI":"10.14309\/crj.2016.84","article-title":"Tangled","volume":"3","author":"M Soubra","year":"2016","journal-title":"ACG Case Rep J"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"82","DOI":"10.3389\/fped.2020.00082","article-title":"An unusual case of hypoproteinemia in childhood: Keep in mind trichobezoar","volume":"8","author":"M Stinco","year":"2020","journal-title":"Front Pediatr"},{"issue":"04","key":"ref34","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.ijpam.2020.05.002","article-title":"Gastric bezoar","volume":"7","author":"F M Sulaiman Ambusaidi","year":"2020","journal-title":"Int J Pediatr Adolesc Med"},{"issue":"11","key":"ref35","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1002\/ccr3.1213","article-title":"Gastric trichobezoar","volume":"5","author":"D J Szor","year":"2017","journal-title":"Clin Case Rep"},{"issue":"07","key":"ref36","doi-asserted-by":"crossref","first-page":"411","DOI":"10.11622\/smedj.2016125","article-title":"A \u2018Hairy\u2019 problem: Trichotillomania, trichophagia and trichobezoars","volume":"57","author":"Y I Yik","year":"2016","journal-title":"Singapore Med J"}],"container-title":["Klinische 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