History Of Trichophagia Research Articles

Primary Trichobezoar in Small Intestine: A Case Report

Trichobezoar is a rare surgical condition that mostly occurs in the stomach and often causes a surgical emergency when left untreated. It is often predisposed by psychiatric conditions, mental retardation, previous gastric surgery, or abnormal anatomy. Trichobezoar progresses extremely slowly and is diagnosed through imaging such as a barium series, endoscopy, or computed tomography. Surgical removal is typically required. The patient in this case was a 12-year-old girl who presented with symptoms of abdominal pain, vomiting, nausea and constipation. She was found to be anaemic and underweight. Contrast-enhanced Computed Tomography (CECT) diagnosed acute intussusception and small bowel obstruction, which were treated by emergency laparotomy. During the operation, a large primary ileal trichobezoar was found in the distal part of the ileum with hair strands extending up to the transverse colon. The absence of masses elsewhere made the diagnosis even more peculiar, as primary intestinal trichobezoar is highly uncommon. Primary closure of the enterotomy was performed as it was viable, and the postoperative period was uneventful. A history of trichophagia was elicited, and a psychiatric assessment of the patient was conducted. Behavioural therapy was initiated for the trichophagia. In conclusion, trichobezoar is a rare surgical entity with modifiable predisposing factors that require a multidisciplinary management approach.

A Young Female with Trichobezoar: A Case Report

Trichobezoars are rare mass of hair usually located in the stomach, but may extend into the small intestine and sometimes up to large bowel. It is usually associated with a history of psychiatric disorders such as trichophagia and trichotillomania. We present a case of trichobezoar in a 14-year-old female with decreasing density of hair, abdominal pain, vomiting and history of trichophagia. The diagnosis was confirmed by CT scan. The patient was managed by exploratory laparotomy with gastrotomy.

Gastroduodenal Trichobezoar: A Case Report

Gastroduodenal trichobezoar is a rare condition, which is easily diagnosed in a suggestive setting. We report the case of a 12 year old female patient with a history of trichophagia, who was admitted to hospital with a large epigastric mass. Imaging was performed, including ultrasound, an unprepared abdomen and an abdominal CT scan, which revealed heterogeneous lesions occupying the entire stomach, not taking contrast and appearing independent of the gastric wall. The aim of our work is to show the interest of imaging in the positive diagnosis of trichobezoar as well as its extension to the gastrointestinal tract and the postoperative control.

Multidisciplinary treatment of massive trichobezoar caused an acute gastric outlet obstruction

Introduction. Trichobezoars presents a rare form of bezoar made of swallowed hair, with clinical manifestation of gastric or intestinal obstruction, gastric ulceration, bleeding, and perforation. It is predominantly found in emotionally disturbed or mentally retarded youngsters, who eating their own hair which is clinically known as trichophagia. Patients often deny eating their own hair which makes diagnosis difficult. Case report. We present a case of acute gastric outlet obstruction caused by a giant gastric trichobezoar made of a long thin hair, in a 20-year young female. Although patient had a long history of trichophagia, she did not think her behavior was unusual and she had not been treated before. Following the initial diagnostic procedures, exploratory laparotomy was indicated. After anterior gastrotomy was performed, a massive stomach-shaped trichobezoar was removed. Postoperatively, the patient had a psychiatric consult exam. She recovered well and was discharged without complications. She was referred for further psychiatric follow-up. Conclusion. Trichobezoars are non-digestible collections that usually accumulates in stomach and can extend to small bowel, causing mechanical injury such as hollow viscus obstruction. Patients with acute gastric obstruction caused by a giant trichobezoar require urgent removal of the trichobezoar, to preserve the stomach and avoid further, catastrophic consequences.

Trichobezoar in young Nepalese girl with Rapunzel syndrome: A case report

Trichobezoar is a gastric foreign body that is composed of the patient’s own hair in the stomach. Rapunzel syndrome is an unusual form of trichobezoar in stomach,which extends into any part of the small intestine.We are reporting the case of gastric trichobezoar with thin tail extending into the duodenum in a twenty year oldgirl. She had a history of trichophagia. She presented with epigastric pain and vomiting. Endoscopic removal was attempted but this was unsuccessful. Subsequently the patient underwent exploratory laparotomy and gastrotomy.She recovered well and was discharged with advice for psychiatric consultation.
 Bangladesh J Medicine January 2021; 32(1) : 69-72

Trichobezoar: a rare clinical rendezvous with twin sisters

Trichobezoar is very uncommon in the pediatric age group. Till now no familial predisposition has been reported. We hereby report our clinical experience with eight years old twin sisters one of whom had a huge gastric trichobezoar and other one had a history of trichotillomania with recurrent vomiting and weight loss. An eight years old female child, one of the twin, presented with history of recurrent vomiting. Abdominal examination revealed firm mass in epigastric region. X-ray abdomen showed the transverse colon pushed down. Ultrasonography revealed echogenic mass in the stomach. Preoperative diagnosis of trichobezoar was achieved by a computed tomography (CT) scan. Laparotomy was done through the midline abdominal incision after initial session of resuscitation. A huge mass of hair was retrieved from the stomach part of which was passing into the duodenum. Patient was found to have underlying trichotillomania and obsessive compulsive disorder. As the patient was one of the twins, other sibling was called and evaluated for the mental health. Interestingly, she was found to have trichotillomania and trichophagia. Examination revealed sparse scalp hair. X-ray and the sonography of the abdomen were normal. Patient was advised endoscopic examination which the guardian of the patient refused. Patient was put on outpatient department (OPD) follow up after psychiatric counselling. Trichobezoar should be suspected in a pediatric patient of gastrointestinal symptoms, epigastric mass and anemia with history of trichophagia. Open surgery gives optimum results. Sibling of an affected twin must be evaluated on the similar lines and managed accordingly.

Ileal Trichobezoar Causing Small Intestinal Obstruction: A Rare Variant

Bezoars are conglomerate mass of ingested foreign material commonly found in stomach and small intestine in patients with psychiatric problems. On the basis of composition bezoars are classified into many variants. Trichobezoar and phytobezoar are most common composed of hair and fibers of fruits and vegetables, respectively. Bezoar itself is a rare entity and the bezoar solely present in small intestine causing intestinal obstruction is rarer, so we present a case report of 7 years old girl presented in our emergency with the feature of intestinal obstruction. Diagnosis was made on the basis of clinical examination, x-ray finding and history of trichophagia. On exploratory laparotomy the cause of obstruction was found to be ileal trichobezoar.

Gastric trichobezoar and Rapunzel syndrome: a case report

Giant gastric trichobezoars are unusual form of foreign body found in stomach of mostly young adolescent females which may lead to morbidity and high mortality 30%, if goes unnoticed. These females have history of trichophagia or trichotillomania. This report is of a 12- year old young adolescent female presented with epigastric pain and mass. An exploratory laparotomy with anterior gastrotomy was performed and a giant trichobezoar with a very large tail of 2.5 ft was removed, weighing 2.52 kg. She recovered well and was discharged on 7th post-operative day. Patient was advised for psychiatric follow up.

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

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.

Tricobezoar gástrico con resolución laparoscópica en mujer adolescente: Reporte de Caso


 
 
 Un bezoar es una masa indigestible atrapada en el tracto gastrointestinal. Está formado por una variedad de materiales que fueron ingeridos intencional o accidentalmente. En el Ecuador no existen datos epidemiológicos de esta patología. El tricobezoar se produce principalmente en asociación con un trastorno psiquiátrico (tricotilomanía y tricofagia). Las modalidades de tratamiento para los tricobezoares incluyen: terapia endoscópica con fragmentación, disolución con líquidos carbonatados, tratamiento médico que implica disolución enzimática y cirugía, incluido el procedimiento laparoscópico. Este tipo de resolución se ha practicado con resultados favorables comparados con la cirugía abierta; sin embargo, aún no se tiene suficiente experiencia en este procedimiento por la baja incidencia de esta complicación. Se presenta el caso clínico de una joven de 17 años con antecedentes de tricofagia, que acudió por dolor abdominal y masa palpable en epigastrio. Mediante historia clínica y exámenes de imagen se diagnosticó de tricobezoar y fue sometida a gastrotomía laparoscópica, con extracción por incisión de Pfannenstiel, con evolución favorable, estadía hospitalaria corta (5 días luego de la intervención quirúrgica), tolerando dieta blanda y siendo dada de alta en buenas condiciones. 
 
 

Rapunzel syndrome and its variants in pediatric patients: Our experience

Background: Rapunzel syndrome is an extremely rare form of trichobezoar extending from the stomach to the small intestine and sometimes even beyond the ileocecal valve. Approximately 50 cases of Rapunzel syndrome have been reported in the literature, and most of them being young women. The aim of this study was to review the clinical features and outcome of pediatric patients with Rapunzel syndrome. Patients and Methods: We present a retrospective study performed from January 1995 to December 2013. The study included eight paediatric patients. The clinical features including history of trichophagia, intraoperative findings, bezoar characteristics and operative were analyzed. Results: The age of patients ranged from 4 years to 15 years. Only one (12.5%) child was in teenage group, whereas the rest of the patients (87.5%) were below the teenage group. There were five (62.5%) females and three (37.5%) males. Patients had varied presentations like chronic abdominal pain (100%), abdominal distension (75%), epigastric fullness (75%), features of intestinal obstruction (50%), and anorexia (25%). Trichophagia could not be elicited in four patients (50%). Impending intestinal perforation and Intussusception was seen in one (12.5%) each. Six (75%) patients had trichobezoar, while plastobezoar (plastic bezoar) and mixed bezoar was present in one (12.5%) each.Conclusions: Rapunzel syndrome is also seen in children below the teenage group. Although more common in females, it is seen in both sex. Chronic abdominal pain and distension are main presenting features, while history of trichophagia is absent in 50% cases. It should be included in the differential diagnosis in children, especially females with chronic abdominal pain, even if history of trichophagia is absent.

Rapunzel Syndrome: a rare cause of acute small bowel obstruction

The Rapunzel syndrome is a very rare condition where trichobezoar hasextended up to the small bowel. Here we are reporting a rare case of Rapunzel syndrome in an adolescent girl with history of trichophagia who presented with small bowel obstruction. Patient underwent exploratory laparotomy and bezoar was removed through gastrotomy. Post-operative course was unremarkable.KEY WORDS: Rapunzel syndrome; Trichobezoars; Psychotherapy; Gastrotomy

Giant Gastric Trichobezoar In A Female Teenager

Trichobezoar is a rare pathology in which swallowed hairs accumulate in the stomach. Large amounts can thus accumulate over the years forming a hair ball. The usual presentatation is with early satiety and malnutrition. The diagnosis may be suspected in young females with abdominal pain, epigastric mass and malnutrition, who have a history of trichophagia. A small trichobezoar can be treated using non-surgical methods, but large bezoars usually require open surgery. In this report, we present one case of a successful laparotomy removal of a giant (500g) gastric trichobezoar in a 17-year-old girl with a 1-year history of trichotillophagia. Physical examination revealed diffuse abdominal pain and an epigastric mass. Psychodynamic aspects, clinical maifestations, diagnosis and therapautic strategies are discussed.

Unusual cause of gastric outlet obstruction: giant gastric trichobezoar: a case report

BackgroundTrichobezoars are caused by hair ingestion. The usual presentation of a trichobezoar is with early satiety and malnutrition. Obstructive symptoms and manifestations of gastric outlet obstruction may occur. The diagnosis may be suspected in young females with malnutrition, who have a history of trichophagia.Case presentationWe report a case of 12-year-old female admitted to the emergency room for abdominal pain. On physical examination, she was cachectic and an epigastric mass was palpated. An exploratory laparotomy was conducted. A giant trichobezoar was palpated in the stomach and was removed through an anterior gastrostomy.ConclusionThere were no complications postoperatively and the patient was referred to a psychiatrist.

Trichobezoar as an expression of emotional disturbance; report of two cases in children.

Trichobezoar is a relatively rare condition. About 180 cases have been reported in the medical literature over a period of 177 years. 1 We are reporting two cases which were seen on our service within the relatively short period of four weeks. We would also like to emphasize the psychological aspects of the condition with respect to etiology and comprehensive treatment. Trichobezoars are usually found in emotionally disturbed persons. 2,3 Approximately 90% of reported cases have involved females. De Bakey and Ochsner 4 reported that 17.6% of such cases occurred in the first decade, 36.6% in the second decade, 27.4% in the third decade, and 4% in the fourth decade. Characteristically, there is a history of trichophagia, halitosis, and anorexia, especially for solids. A history of vomiting, abdominal pain, and weight loss may occasionally be elicited. Significant physical findings are limited to a palpable abdominal mass and slight to moderate

Trichobezoar or Hair Ball

The origin of the term bezoar as a designation of foreign substances in the stomach, the early history of trichobezoars, or hair balls, and the superstitions associated with them comprise an interesting study, for which one is referred to the classic paper by Matas (9). The subject of bezoars has also been comprehensively reviewed by DeBakey and Ochsner (5). Their collected series numbered 311 of all types and included 171 trichobezoars, to which they added another, making a total of 172 authentic cases reported to 1938. The number has since been added to by Collins (3), Summey and Borzell (13), Levy and Smith (8), Harris (6), Lear and Brady (7), Miller and Kert (10) (3 cases), Sarnoff and Sarnoff (12), Clayton-Mitchell (2), and Watt and Harner (14). The case to be recorded brings the total to 184. Most gastric hair casts are discovered in females between ten and thirty years old. The patients usually have long hair, and in most instances it will be found that the habit of hair eating, or trichophagia, became established at an early age. DeBakey and Ochsner believe that there probably exists some neurogenic or psychogenic background to account for this practice. The symptoms and clinical findings are not characteristic. After the hair ball has reached sufficient proportions to cause gastric irritation, there may be nausea, loss of appetite, dyspepsia, headaches, epigastric pain, and mild anemic symptoms. With increase in size, pain becomes more severe, the patient is able to eat less, and there may be blood in the stools. If the hair ball becomes large enough, symptoms of obstruction may develop. For the diagnosis, a history of trichophagia and the presence of an upper abdominal tumor are significant. Other masses, as an enlarged spleen, enlarged or floating kidney, cysts of the liver, spleen, or kidney, and tumors of the omentum, pancreas, stomach, and colon must be ruled out. According to DeBakey and Ochsner, the first correct roentgen diagnosis of a hair ball in the stomach seems to have been made by Kaufman in 1911. Another early preoperative diagnosis was made by O'Brien (11) in 1918. The intragastric mass produces an irregular negative shadow, which can often be seen to move within the barium-filled stomach. Peristalsis is usually absent and the gastric air bubble is frequently obliterated. The six-hour film shows the barium caught on the surface of the hair ball, and this appearance may persist at the end of twenty-four hours or longer. In this connection the suggestion is offered that the stomach be filled with air at the time of the six-hour and twenty-four-hour films in order to obtain a better double contrast of the hair ball and gastric mucosa. This was not done in the case reported here for fear of rupturing an associated penetrating gastric ulcer. The only treatment is surgical. This aspect is covered in the papers of Matas and of DeBakey and Ochsner. Recurrence is rare; Bennett (1) reported a case.