Paediatric gastrointestinal trichobezoar—an uncommon entity: a case series with recent literature review

Abstract

BackgroundGastrointestinal (GI) tract bezoars are aggregates or concretions of inedible and undigested material mostly found in the stomach but can also be found elsewhere in the gastrointestinal tract. Trichobezoar, an infrequent form of bezoar seen mostly in young females, consists of a compact mass of swallowed hair. It is primarily located in the stomach but may extend through the pylorus into the duodenum and small bowel, a condition labelled as Rapunzel syndrome.Cases presentationIn this series, we report four consecutive cases of trichobezoars in the paediatric age group, all managed at a single institution King Saud Medical City Hospital Riyadh between 2019 and 2022. All the cases were girls between the ages of ten to fourteen with psychosocial problems. All the patients had a definite mass in the epigastrium and a history of not gaining weight. One presented with intestinal obstruction. X-ray abdomen and computed tomography (CT) scan abdomen were the imaging modalities that led to the diagnosis. All patients underwent surgery with successful removal of the trichobezoar and were referred to a psychiatrist for evaluation and treatment of a psychological disorder.ConclusionTrichobezoar is a rare entity that should be considered as a differential diagnosis in young female patients with vague, non-specific clinical symptoms and a palpable, upper-abdominal mass. In our experience and in line with the published literature, conventional laparotomy is still the gold standard in cases of GI trichobezoars.Along with the removal of the trichobezoar, treatment of the existing psycho-social ailment is of utmost importance and needs long-term counselling with periodic psychological evaluation in follow-up clinics to avoid recurrence.