A giant trichobezoar in a child with attention deficit hyperactivity disorder: A case report

Abstract

Introduction and importanceTrichobezoars are uncommon gastrointestinal concretions that develop due to the accumulation of ingested hair, predominantly affecting young females with concurrent psychiatric conditions like trichotillomania and Trichophagia. These masses typically form in the stomach but may also protrude into the intestines, potentially leading to severe complications if not promptly identified and treated. The present case study outlines the clinical manifestation, diagnostic complexities, surgical intervention, and postoperative care of a 10-year-old female patient with a substantial gastric trichobezoar, underscoring the significance of considering this disorder in pediatric individuals with gastrointestinal manifestations and a psychiatric history. Case presentationThe research article details the case of a 10-year-old female patient with a multifaceted medical history, which includes attention-deficit/hyperactivity disorder (ADHD), chronic constipation, growth retardation, and a background of neonatal seizures. She was admitted to the emergency department presenting with epigastric pain, nausea, and vomiting. Notably, the patient displayed pica-like behaviors, specifically the ingestion of hair, which ultimately led to the diagnosis of a trichobezoar, a form of gastric obstruction resulting from the accumulation of ingested hair. Diagnostic imaging techniques, including abdominal X-ray and computed tomography (CT) scan, confirmed the presence of a substantial trichobezoar within the stomach, necessitating surgical intervention via exploratory laparotomy for removal. The pathological examination of the excised mass revealed a considerable quantity of hair intermingled with fecal matter. Following the surgical procedure, the patient exhibited a positive recovery trajectory and was subsequently referred for psychiatric assessment and behavioral therapy to address the underlying issues associated with trichotillomania, with the objective of preventing future occurrences. This case underscores the critical need for the identification and management of behavioral concerns in pediatric patients exhibiting similar clinical presentations. DiscussionThe patient exhibited symptoms such as epigastric pain, nausea, and vomiting, in addition to a medical history of Attention Deficit Hyperactivity Disorder (ADHD) and pica-like behaviors. Diagnostic imaging confirmed the presence of a large trichobezoar, leading to the necessity of an exploratory laparotomy for its surgical removal. This case highlights the crucial role of comprehensive clinical assessment and imaging in the diagnosis of trichobezoars, especially in children with behavioral concerns. Managing such cases typically involves a multidisciplinary approach that combines surgical procedures with psychiatric assessment and behavioral therapy to reduce the likelihood of recurrence. ConclusionThis case underscores the importance of considering trichobezoars in the list of potential diagnoses for pediatric patients exhibiting gastrointestinal symptoms, particularly in individuals with psychiatric or neurodevelopmental histories. Timely identification and management are crucial in averting serious complications linked to trichobezoars. The favorable surgical result in this particular patient underscores the significance of holistic care that attends to both the physical and psychological dimensions of the condition, ultimately enhancing the long-term outlook. Additional research is required to explore the relationship between underlying psychiatric conditions, particularly ADHD, and the formation of trichobezoars. Furthermore, novel therapeutic strategies need to be developed.