CASE REPORT   

Chirurgia 2019 February;32(1):48-50

DOI: 10.23736/S0394-9508.18.04860-X

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Trichobezoar: a bizarre gastric obstruction

Hamed ALWADAANI ¹, Abdaljaleel S. ABUALSAUD ², Abdullah S. ALQATTAN ² ✉, Mahmoud MACHMOUCHI ³, Ahmed ELSEROUGI ³

¹ General surgery consultant, King Faisal University, Al Hofuf, Saudi Arabia; ² College of Medicine, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; ³ Department of Surgery, Almoosa Specialist Hospital, Al Hofuf, Saudi Arabia; ⁴ Department of General Surgery, Almoosa Specialist Hospital, Al Hofuf, Saudi Arabia

Trichobezoar is a rare condition in which an undigested ball of hair is found in the gastrointestinal tract. Trichobezoars are seen in 90% of adolescent females who suffer from trichotillomania, which is recurrent hair pulling, and trichophagia, which is hair eating. We report a case of a 5-year-old girl, with a history of trichotillomania, who presented to our emergency department complaining of epigastric abdominal painpostprandial vomiting, loss of appetite for the last 2 days, unintentional weight loss and history of trichotillomania for the last 6 months. Upper GI series and upper GI endoscopy confirmed the presence of a trichobezoar in the lower esophagus; however we could not reach with endoscopy beyond the lower gastroesophageal junction. Endoscopic removal was attempted but it was unsuccessful so laparotomy was done for the trichobezoar removal which was successful and the patient had an uneventful postoperative course. Trichobezoars occur in 1% of patients with trichophagia. Although they are rare in this age group, a high index of suspicion should be kept in patients with trichophagia. Symptoms and complications of trichobezoars depend on their size. Patients may be asymptomatic or may present with symptoms of GI tract obstruction. Treatment options depend on the size and type of bezoars as well. These options include; 1) dissolution via nasogastric lavage; 2) endoscopic removal; 3) surgical removal. Trichobezoars should be considered in patients with history of trichophagia regardless of their age or gender. Endoscopic removal should be attempted in small and proximal trichobezoars. Surgical approach remains the treatment of choice in most cases as it allows for better visualization and examination of all the gastrointestinal tract in a short time.

KEY WORDS: Endoscopy - Gastric outlet obstruction - Bezoars - Trichotillomania