Abstract
Introduction. A bezoar is a conglomerate comprising partially digested or undigested matters, impacted in the stomach. Trichobezoars (agglomerations of hair) occur most frequently in patients with mental disorders (trichotillomania) and represent a rare pathology that can entail diagnostic and therapeutic difficulties. Material and method. We are reporting a gastric trichobezoar case in 12 years old female patient with no pathological personal history, admitted for epigastric pain and food vomiting. Clinical examination revealed an epigastric formation of approx. 5/3cm, rigid, immobile and adhering to the deep structure, while laboratory tests revealed a mild microcytic hypochromic anemia. Upper gastrointestinal endoscopy provided visualization of a giant trichobezoar of approximately 17 cm, visible from the subcardial region down to the antral region, hooked by one hair onto an area with a pseudopolypoid inflammatory aspect located in the prepyloric region. The patient was referred to the pediatric surgery department, as the size of the trichobezoar did not allow for its endoscopic extraction. The initial attempt for laparoscopic extraction was unsuccessful and required a minimal left subcostal laparotomy, followed by gastrotomy with evacuation of the gastric trichobezoar. The postsurgical evolution was favorable. Discussions. Despite its low prevalence in humans, mortality can sometimes reach 30% in certain cases due to the bleeding, obstruction, peritonitis or ultimately the gastrointestinal perforations that could occur. Various endoscopic methods were reported for bezoar extractions, such as shock wave lithotripsy, removal via aspiration using a large gauge endoscope, extraction with polypectomy snare and biopsy forceps. Conclusion. The rareness of this pathology in the pediatric population requires a very careful differential diagnosis. The therapeutic difficulties result from the size of the trichobezoar, while the prognosis depends on the underlying psychiatric pathology.
Highlights
A bezoar is a conglomerate comprising partially digested or undigested matters, impacted in the stomach
The trichotillomania diagnosis is suspected when the compulsive hair pulling behavior is not justified by a general medical condition or another psychiatric disorder, and it can be confirmed via upper gastrointestinal endoscopy
Psychiatric or psychological evaluation is essential given that underlying emotional stress is often a triggering factor for trichophagia or trichotillomania as observed in affected patients
Summary
Oana-Maria Rosu, MD, Flavia Luca, MD, Ana-Maria Scurtu, MD, Assoc. Marin Burlea, MD, PhD 1“Sf. Maria” Clinical Emergency Children’s Hospital, Iasi. 4“Dunărea de Jos” University, “Elena Doamna” Psychiatry Hospital, Galati 5“Titu Maiorescu” University, Faculty of Medicine, Pediatric Gastroenterology Clinic –. “Sf. Maria” Clinical Emergency Children’s Hospital, Iasi 6“Gr. T. Popa” University of Medicine and Pharmacy, Iasi, Pediatric Gastroenterology
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