{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T06:56:14Z","timestamp":1790837774808,"version":"4.1.0"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"\n Background<\/jats:title>\n Giant gastric trichobezoar is a rare foreign body resulting from chronic hair ingestion and may lead to serious complications, including obstruction, perforation, and malnutrition. Conventional endoscopic removal often fails due to its large size, smooth, elastic surface, and tensile strength. Therefore, surgery is often the standard treatment. In this report, we discuss the case of a girl with a giant trichobezoar containing cotton threads, which was successfully removed following forceps-assisted mechanical fragmentation and transparent cap-assisted extraction.<\/jats:p>\n <\/jats:sec>\n \n Case summary<\/jats:title>\n A 7-year-old girl with a 5-year history of trichophagia presented with abdominal pain, distension, palpable mass, and iron-deficiency anemia. Imaging and endoscopy revealed a 12\u2005cm\u2009\u00d7\u20096\u2005cm gastric trichobezoar. As surgery was declined, endoscopic removal under general anesthesia was performed. The procedure used high-power electrocoagulation (EndoCut\/Forced Coag mode) to segment the dense bezoar, followed by piecemeal extraction with forceps and cap-assisted removal to prevent cardia laceration and esophageal injury. The trichobezoar was successfully removed without mucosal injury, and the patient was discharged 4 days after the endoscopic procedure with complete resolution of symptoms.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n With strict patient selection, multidisciplinary teamwork, and adequate expertise and equipment, endoscopic treatment may offer a minimally invasive alternative to the surgical removal of giant gastric trichobezoars in selected pediatric cases. Psychological support is also important to address underlying behavioral factors that may lead to recurrence.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fmed.2026.1950339","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T06:05:11Z","timestamp":1790834711000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Endoscopic removal of a giant complex gastric trichobezoar: an alternative strategy using combined techniques"],"prefix":"10.3389","volume":"13","author":[{"given":"Hai-Hua","family":"Zhou","sequence":"first","affiliation":[{"name":"Department of Endoscopy Center, Xiaolan Clinical Institute of Shantou University Medical College","place":["Zhongshan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian-Ping","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Oncology, Xiaolan Clinical Institute of Shantou University Medical College","place":["Zhongshan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui-Qiang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Endoscopy Center, Xiaolan Clinical Institute of Shantou University Medical College","place":["Zhongshan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wang","family":"Miao","sequence":"additional","affiliation":[{"name":"Department of Endoscopy Center, Xiaolan Clinical Institute of Shantou University Medical College","place":["Zhongshan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin-Jin","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Xiaolan Clinical Institute of Shantou University Medical College","place":["Zhongshan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Xiaolan Clinical Institute of Shantou University Medical College","place":["Zhongshan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Endoscopy Center, Xiaolan Clinical Institute of Shantou University Medical College","place":["Zhongshan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuai","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Endoscopy Center, Xiaolan Clinical Institute of Shantou University Medical College","place":["Zhongshan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1097\/RC9.0000000000000216","article-title":"Case series of pediatric gastric trichobezoars: diagnostic challenges, management outcomes, and the imperative for psychiatric follow-up","volume":"138","author":"El-Mefleh","year":"2026","journal-title":"Int J Surg Case Rep"},{"key":"B2","doi-asserted-by":"publisher","first-page":"S953","DOI":"10.14309\/01.ajg.0000782448.05456.a0","article-title":"S2229 a hairy situation: recurrent trichobezoar in a patient presenting with abdominal pain and emesis","volume":"116","author":"Mensah","year":"2021","journal-title":"Am J Gastroenterol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"857374","DOI":"10.1155\/2013\/857374","article-title":"Rapunzel syndrome: a rare postpartum case","volume":"2013","author":"Tegene","year":"2013","journal-title":"Case Rep Gastrointest Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"72","DOI":"10.37506\/8fkv5f77","article-title":"A systematic review and meta-analysis of clinical perspective in trichotillomania","volume":"15","author":"Dimple","year":"2024","journal-title":"Indian J Public Health Res Dev"},{"key":"B5","doi-asserted-by":"publisher","first-page":"85","DOI":"10.5152\/tjg.2020.18890","article-title":"Bezoar in upper gastrointestinal endoscopy: a single center experience","volume":"31","author":"Gokbulut","year":"2020","journal-title":"Turk J Gastroenterol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"860","DOI":"10.1148\/69.6.860","article-title":"Trichobezoar: with a case report","volume":"69","author":"McGee","year":"1957","journal-title":"Radiology"},{"key":"B7","first-page":"220","article-title":"Trichobezoar associated with gastric polyposis","volume":"149","author":"Bates","year":"1988","journal-title":"West J Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1186\/s12893-026-03628-2","article-title":"Transumbilical single-incision laparoscopic-assisted removal of gastric trichobezoars in children: a technical refinement and feasibility study","volume":"26","author":"Maher","year":"2026","journal-title":"BMC Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"102185","DOI":"10.4253\/wjge.v17.i1.102185","article-title":"Novel approach to managing two enormous bezoars with successive snare-tip electrocautery: a case report","volume":"17","author":"Lim","year":"2025","journal-title":"World J Gastrointest Endosc"},{"key":"B10","doi-asserted-by":"publisher","first-page":"59","DOI":"10.17235\/reed.2024.10880\/2024","article-title":"A giant luminal bezoar treated by mechanical lithotripsy using a yellow zebra guide wire","volume":"118","author":"Yuan","year":"2026","journal-title":"Rev Esp Enferm Dig"},{"key":"B11","doi-asserted-by":"publisher","first-page":"E1063","DOI":"10.1055\/a-2462-1897","article-title":"Endoscopic retrieval of a huge gastric trichobezoar after thermally induced cutting with a hook knife","volume":"56","author":"Wei","year":"2024","journal-title":"Endoscopy"},{"key":"B12","doi-asserted-by":"publisher","first-page":"S986","DOI":"10.14309\/01.ajg.0001145908.06378.07","article-title":"S4612 a hairy situation: endoscopic removal of large gastric trichobezoar with a jejunal surprise","volume":"120","author":"Pandey","year":"2025","journal-title":"Am J Gastroenterol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e357","DOI":"10.1002\/deo2.357","article-title":"Successful endoscopic treatment of a huge trichobezoar in a 10-year-old girl","volume":"4","author":"Matsuura","year":"2024","journal-title":"DEN Open"},{"key":"B14","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1080\/17474124.2023.2242243","article-title":"Electrosurgical unit in GI endoscopy: the proper settings for practice","volume":"17","author":"Jena","year":"2023","journal-title":"Expert Rev Gastroenterol Hepatol"},{"key":"B15","year":"2026"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1563","DOI":"10.1038\/ajg.2009.105","article-title":"Electrosurgery in gastrointestinal endoscopy: principles to practice","volume":"104","author":"Morris","year":"2009","journal-title":"Am J Gastroenterol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"172","DOI":"10.3389\/fped.2018.00172","article-title":"Analysis of radiopaque gastrointestinal foreign bodies expelled by spontaneous passage in children: a 15-year single-center study","volume":"6","author":"Yeh","year":"2018","journal-title":"Front Pediatr"},{"key":"B18","doi-asserted-by":"publisher","first-page":"S1098","DOI":"10.14309\/00000434-201610001-02273","article-title":"Bezoars: a rare, late complication of roux-en-Y gastric bypass and a novel endoscopic technique for treatment","volume":"111","author":"Kanwar","year":"2016","journal-title":"Am J Gastroenterol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"20","DOI":"10.21037\/pm-25-41","article-title":"Trichobezoars in pediatric surgery: a narrative review of clinical perspectives, surgical strategies, and psychological considerations","volume":"8","author":"Alami Hassani","year":"2025","journal-title":"Pediatr Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1007\/s44337-024-00132-5","article-title":"Gastric trichobezoar as first presentation of psychiatric disorders in young women: Case Series","volume":"1","author":"Elnaim","year":"2024","journal-title":"Discov Med"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1950339\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T06:05:15Z","timestamp":1790834715000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1950339\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,1]]},"references-count":20,"alternative-id":["10.3389\/fmed.2026.1950339"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1950339","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,1]]},"article-number":"1950339"}}