Diagnosis and Surgical Extraction of Large Gastric Trichobezoars: A Single Center Study of Two Cases

Tulika Saggar,Varun Saggar

doi:10.11648/j.ijg.20200402.14

Abstract

Trichobezoars are compact mass of hair occupying the gastric cavity that if left untreated can cause developmental delay, malnutrition, obstruction or perforation. The treatment options include extraction by conventional laparotomy, laparoscopy, gastrotomy or endoscopy. Since they are almost always associated with trichotillomania and trichophagia or other psychiatric disorders, psychiatric consultation is necessary to prevent relapses. We reviewed the medical charts of two patients with trichobezoar who were treated at Lord Mahavir, Civil Hospital, Ludhiana. Both the cases, aged 14 and 19 years were females and presented at the hospital with a history of epigastric discomfort, pain and vomiting. Both the girls were lean, underweight and pale skinned. First patient had trichotillomania and trichophagia for 1 year prior to presentation. The parents were unaware of patient’s trichophagia but the girl revealed that she ate hair during the night. The second patient had no history of trichophagia and the bilateral loss of scalp hair indicated nocturnal involuntary eating of hair during sleep. The large palpable mass in both the cases was non-tender, hard, smooth and mobile on examination. The abdominal imaging with CT revealed the mass occupying most of the gastric cavity, and turned out to be trichobezoars. The masses were successfully extracted by laparotomy and gastrotomy. A trichobezoar represents a serious surgical condition. It is important to consider such diagnosis in face of suggestive symptoms, even if signs of trichotillomania are not present. Gastrotomy was found to be very successful for the surgical removal of trichobezoars. The behavioral assessment and psychiatric counselling also plays a useful role in patient management and prevention of recurrence.

Highlights

Trichobezoar is a rare medico-surgical condition, comprising of compact mass of hair occupying the gastric cavity to a varying extent, mostly affecting young women [14]
This study aims to report our experience at a single institution with the rare and complex trichobezoar condition and the successful extraction by laparotomy and gastrotomy
All the characteristic symptoms including nausea, vomiting, epigastric colicky pain along with trichotillomania and trichophagia were reported in both the cases in this study

Summary

Introduction

Trichobezoar is a rare medico-surgical condition, comprising of compact mass of hair occupying the gastric cavity to a varying extent, mostly affecting young women [14]. Trichobezoar is confined to stomach and rarely extends through the pylorus into jejunum, ileum or even colon [5, 6]. The complications associated with trichobezoars include gastric mucosal erosion, ulceration, intussusception, obstructive jaundice, proteinlosing enteropathy, pancreatitis and death [6, 9,10,11]. In cases with visceral perforation and peritonitis, the mortality approaches 100% in the absence of a surgical intervention [10]. [16] A number of predisposing factors may contribute to the risk of bezoar formation, primarily previous gastric surgery as reported in as many as 20% of patients. Other risk factors include diabetes mellitus, trichotillomania, trichophagia, anxiety disorders, psychiatric disorders, poor mastication, excessive intake of fiber and cystic fibrosis [5, 17]

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