Volume 89 - 2026 - Fasc.2 - Case series
Therapeutic challenges in the multidisciplinary approach of liver transplant-associated biliary tract complications in Roux-en-Y gastric bypass patients
Introduction: This case series addresses the available non-surgical approaches for the management of biliary tract complications in liver transplant (LT) patients with a history of Roux-en-Y gastric bypass (RYGB).
Methods: Descriptive single center case series of endoscopic and radiological treatments of biliary tract complications in LT recipients with a history of RYGB.
Results: Balloon enteroscopy-assisted-ERCP (BE-ERCP), endoscopic ultrasound (EUS)-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE), percutaneous transhepatic biliary drainage (PTBD), or a combination of these procedures are used according to the clinical indication or the surgical biliary reconstruction (duct-to-duct anastomosis vs hepaticojejunostomy) in conjunction with RYGB. Case 1 was treated with PTBD, followed by BE-ERCP; case 2 with BE-ERCP, followed by EDGE; case 3 with PTBD, followed by EDGE; and case 4 with BE-ERCP.
Conclusion: Both BE-ERCP, EDGE and PTBD in different combinations are reliable non-surgical therapeutic approaches for treating LT-associated biliary tract complications in RYGB patients.
Gastric Trichobezoars in Children and Adolescents: A Single-Center Case Series
Background: Trichobezoars are masses composed of ingested hair, typically affecting children and adolescents with trichotillomania and trichophagia. Their nonspecific presentation often delays diagnosis and may result in complications such as malnutrition or gastric perforation. This study describes our experience in managing pediatric trichobezoars at a tertiary pediatric center in Europe.
Methods: Retrospective single-center case series of gastric trichobezoar cases in children treated at a tertiary pediatric hospital in Brussels, Belgium, between 2020 and 2025. Data extracted from electronic medical records included demographic, clinical presentation, comorbidities, imaging findings, therapeutic approach, complications, and outcomes.
Results: Five pediatric patients (four females; age 6–15 years) were diagnosed with gastric trichobezoars. Recurrent vomiting, abdominal pain, early satiety, and constipation were the most common symptoms. Psychiatric or behavioral comorbidities were present in all cases, including trichotillomania, trichophagia, anxiety, or autism with pica. Ultrasound and plain radiography were unhelpful in all cases. CT raised suspicion of a bezoar in each patient, leading to endoscopic confirmation in three; however, the size of the trichobezoars prevented endoscopic removal. All patients underwent gastrotomy for bezoar extraction, performed via laparotomy in four cases and a laparoscopy-assisted approach in one. Postoperative complications occurred in two patients, including wound infection in two cases and postoperative pneumoperitoneum requiring re-exploration in one case. All patients received psychiatric follow-up, and clinical outcomes were favorable.
Conclusions: Pediatric trichobezoar is a cause of recurrent vomiting that needs invasive intervention. Nonspecific symptoms and psychiatric comorbidities often delay recognition, and CT imaging is needed to establish the diagnosis, which can then be confirmed by endoscopy. Multidisciplinary management involving pediatrics, gastroenterology, and psychiatry is essential to prevent recurrence.