Ingestion Of Hair Research Articles

Gastric Trichobezoar Mimicking a Large Abdominal Tumour: Case report

Background: A bezoar is a collection of indigestible substances that, after swallowing, form a mass in the gastrointestinal tract, most often in the stomach. A trichobezoar is a mass made of ingested, undigested hairs and food remains, while ingestion of hair is called trichophagia. This is an extremely rare condition, with 90% of cases occurring among women, out of which 80% are under the age of 30. The diagnosis is based on clinical examination, findings obtained through radiological modalities (ultrasound and computed tomography) and endoscopy. Objective: The aim of this article is to present the case of a 17-year-old female patient who visited the doctor due to abdominal pain and a visible mass in the projection of the stomach. Case presentation: The patient, accompanied by her parents, and following the instructions of a general practitioner who suspected the presence of a tumour in the abdomen, reported to the surgical clinic. The US examination revealed the presence of a heteroechoic mass in the stomach area, but it could not be determined with certainty where it belonged (Samsung Medison V8 ultrasound system). The CT scans revealed the presence of an inhomogeneous structure in the stomach area occupying the entire volume of the stomach. The mentioned structure included the presence of internal air particles and marginal imbibition of the orally applied contrast agent. The described structure did not infiltrate the stomach wall and, based on the CT scan, the diagnosis established was a bezoar. Under general anaesthesia, a laparotomy with a gastrotomy was performed, and a hard hook shaped mass composed of hair and remains of undigested food was removed from the stomach. Conclusion: A mobile, palpable mass located in the abdomen of younger female patients accompanied by abdominal symptoms, especially in patients where there is information about hair pulling and swallowing, may suggest trichobezoar. The golden standard for trichobezoar presentation is upper endoscopy. If unavailable, the diagnosis is established by a CT scan, preferably with oral application of a contrast agent. Treatment of larger trichobezoars is surgical, while endoscopic and laparoscopic removal is possible only in the case of small trichobezoars.

Impending perforation near ileocecal junction due to phytobezoar impaction and intraluminal polyp: a\xa0case report

IntroductionBezoars and polyps are an uncommon cause of mechanical intestinal obstruction. There are four different kinds of bezoars: phytobezoars, made of vegetables and fibers; trichobezoars, resulting from the ingestion of hair and frequently an expression of psychiatric disorders; lactobezoars, which are formed of milk curd; and pharmacobezoars, caused by drugs and medications. Signs and symptoms classically vary from abdominal pain to constipation, nausea, vomiting, and abdominal distension. We present a rare case of impending perforation along with an intraluminal polyp near ileocecal junction due to phytobezoar impaction.Case presentationOur patient was a 59-year-old Sindhi female with a known history of interstitial lung disease and hypertension who presented to the emergency department with complaints of abdominal pain and constipation for 1 week, vomiting for 5 days, and abdominal distension for 2 days. After a preoperative examination and her failure to respond to conservative therapy, she was taken to the operating room for exploratory laparotomy. A hard intraluminal mass was suspected to be obstructing the small bowel at the site of impending perforation. This mass was a phytobezoar along with an intraluminal polyp. Resection of the affected segment was performed, followed by ileoileal anastomosis, and a drain was left. The patient was discharged 1 week later and was found to be well with no complaints at 3 weeks follow-up.ConclusionsEarly diagnosis of bezoars is important for early intervention and prevention of complications. Our case is unique as phytobezoar with intraluminal polyp is a rare clinical finding. Moreover, the signs and symptoms with which the patient presented are nonspecific and can be seen with multiple surgical emergencies.

Rapunzel Syndrome: A Rare Presentation with Intestinal Intussusception

A bezoar is a collection of foreign material in the gastro-intestinal tract. A trichobezoar is a bezoar formed by the ingestion of hair. When the bezoar extends into the small intestine it is called as Rapunzel syndrome. Rapunzel syndrome is an extremely rare intestinal condition in humans. Trichobezoar with Rapunzel syndrome is an uncommon diagnosis in children is predominantly found in emotionally disturbed or mentally retarded youngsters can even present with complications like intestinal obstruction, perforation and peritonitis. Here we present a rare case of Rapunzel syndrome with intestinal intussusception in a 6 year old girl.

Trichopsychodermatology: trichotillomania and trichophagia leading to Rapunzel syndrome

IntroductionThe Rapunzel syndrome occurs when the trichobezoar (hair ball) extends beyond the small intestine and sometimes even into the colon, producing long, tail-like hair extensions.AimTo present cases of trichobezoars, an extremely rare human intestinal disease caused by the ingestion of hair (trichophagia).Material and methodsIn this retrospective study, we assessed the medical records of 2 patients diagnosed with Rapunzel syndrome admitted to Academic Clinical Hospital No. 2 in Rzeszow, Poland.ResultsThe first patient was a 15-year-old girl. The abdominal ultrasound examination revealed an abnormal, non-compressible structure with the approximate dimensions of 12 × 11 cm in the epigastrium, with a strong shadow obscuring the view. Gastroscopy was performed and a tumour sample was taken for histopathological examination, which confirmed the diagnosis of a trichobezoar. The patient’s mother did not agree to her daughter’s psychiatric treatment. The second patient was a 15-year-old girl who reported to the Emergency Room in critical condition due to dehydration and long-term emesis with symptoms of cachexia. Ileotomy with the removal of two trichobezoars with a diameter of about 5 cm and 7 cm was performed. The patient was discharged for treatment at the Mental Health Clinic for trichotillomania.ConclusionsTrichobezoars give non-specific symptoms that may imitate other diseases for example tumours. Psychotherapy is the recommended treatment and follow-up visits are important in preventing relapses.

An Unusual Form of a Trichobezoar Causing a Peculiar Case of Appendicitis: A Case of Rapunzel Syndrome

Rapunzel syndrome is an extremely rare intestinal condition stemming from trichophagia (compulsive ingestion of hair). The syndrome usually causes intestinal obstruction but we report a unique case where it has caused appendicitis. We also reviewed the existing literature on Rapunzel syndrome.

Gastric Outlet Obstruction by Trichobezoar, A Case Report

A trichobezoar is a bezoar ( a mass found tapped in the gastrointestinal system) formed from the ingestion of hair. Trichobezoars are often associated with trichotillomania (compulsive hair pulling). Trichobezoars are rare, but can be fatal if undected1,2. Surgical intervention is often required. Gastric outlet obstruction (G.O.O) is one of the presenting complaints of trichobezoars in the stomach. Patients with this condition often have an underlying psychiatric illness & history may not be easily forthcoming. This condition mainly occurs in young female. We are presenting a case of gastric outlet obstruction in a young female of 25 years old. After taking history, clinical examination, necessary investigation it seemed to be a case of trichobezoar. Laparatomy done under general anaesthesia, then opened the stomach and found it was a case of trichobezoar.J Shaheed Suhrawardy Med Coll, December 2017, Vol.9(2); 85-87

Trichobezoar due to psychiatric co-morbidity: A rare case report

Trichobezoar (hair ball) is characterized by the accumulation of hair in the gastrointestinal tract. It is formed by trichophagia (ingestion of hair) and often associated with trichotillomania (compulsive hair pulling) and other psychiatric disorder or neurological problems. We report a case of 19-year-old female who had a trichobezoar. Trichotillomania and depression are the common psychiatric disorders associated with trichobezoar, hence it should be always looked for and treated along with its surgical management. The patient underwent laparotomy during which a large trichobezoar was removed. This case report highlights the importance of psychiatric and comprehensive approaches.

A Rare Case of an Early Postoperative Obstructive Ileus in a Young Female Patient due to a Residual Trichobezoar Mass.

Trichobezoar is a rare cause of small bowel obstruction, whereby a mass forms most commonly in the stomach and duodenum of young females, from ingestion of hair, a condition known as trichophagia. We present a case of recurrent small bowel obstruction due to a residual hair mass that was removed surgically in a young female patient who had a laparotomy and gastrotomy for removal of a large gastric trichobezoar just two weeks prior to the current admission. This case illustrates the importance of a thorough inspection of the whole bowel to ensure that no residual bezoars remain after surgery.

Influence of dietary feathers on the fecal microbiota in captive Arctic fox: do dietary hair or feathers play a role in the evolution of carnivorous mammals?

Hair and feathers are composed of keratin and are indigestible, inalimental and unpalatable for carnivores. However, carnivores often ingest hair and feathers during feeding or when grooming. We hypothesized that ingestion of hair and feathers changes species diversity and relative abundance of bacteria in the gut of carnivores. To test this hypothesis, we added disinfected poultry down feathers to the normal diet of captive Arctic foxes (Alopex lagopus). We then used fluorescently labeled terminal restriction fragments (T-RFs) to examine changes in fecal bacterial diversity and abundance. The results showed that the number of bacterial species increased significantly after feather ingestion, but that total abundance was unchanged. This demonstrated that addition of disinfected feathers to the diet stimulated increased production among less abundant bacteria, resulting in a balancing of relative abundance of different bacterial species, or that some newly-ingested microbial species would colonize the gut because a suitable microhabitat had become available. This implies that the overall production of bacterial metabolites would be made up of a greater range of substances after feather ingestion. On one hand, the host's immune response would be more diverse, increasing the capacity of the immune system to regulate gut microflora. On the other hand, the animal's physiological performance would also be affected. For wild animals, such altered physiological traits would be subjected to natural selection, and, hence, persistent geographic differences in the character of ingested feathers or fur would drive speciation.

Approach to Trichobezoar Cases in Children: Literature Review

Trichobezoar is a mass found trapped in the gastrointestinal system formed from the ingestion of hair. They are mostly localized inside the stomach, and they can occasionally extend from the pylorus into the duodenum and small intestines. At the same time, they are almost always associated with trichotillomania, trichophagia, and other psychiatric diseases. Trichobezoar can be easily confused with other diseases characterized by abdominal pain and vomiting. Removal of the mass with laparotomic, laparoscopic, and endoscopic interventions is an available treatment approach. Among them, the laparotomic approach is the most effective treatment modality. Herein, we present a case and reviewed the literature from a general outlook in order to emphasize current, updated approaches to the pediatric cases with trichobezoar.

Rapunzel Syndrome—A Rare Cause of Multiple Jejunal Intussusception

Trichobezoars are usually without symptoms until they reach a large size. The "Rapunzel" syndrome is a trichobezoar with a long tail extending from the stomach to small bowel. We report the case of a 6-year-old girl with a history of trichotillomania and hair ingestion for three years, who presented with multiple jejunojejunal intussusceptions due to a trichobezoar with a long, 90-cm tail into the small bowel. To our knowledge, this is the first report of trichobezoars as a cause of jejunal intussusceptions, which should be suspected in the appropriate clinical circumstances.

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.

The Role of Endoscopy in a Patient with Recurrent Gastric Trichobezoar

Purpose: Bezoars are accumulations of food and fiber in the alimentary tract. We present a case of a patient with recurrent trichobezoar in which endoscopic removal was tedious, time consuming, and ultimately unsuccessful. Methods: CASE:A 37-year-old female with medical history of hypertension and depression was admitted with nausea, vomiting and constipation for four days. It started 1 month ago with bloating, early satiety and weight loss of 40 pounds. Her medical history was significant for trichotillomania, and trichobezoar 18 months ago, which was removed successfully endoscopically over 2 days. On physical exam, she was of moderate built, malnourished, with a HR of 103 and BP of 156/91 mmHg. Scalp examination revealed sparse hair and red colored extensions that were missing in some areas. Abdominal exam was significant for mild epigastric fullness and tenderness on palpation. Labs were significant for a Hb of 10.4 g/dL. An abdominal radiograph showed a dilated loop of duodenum measuring 4.6 cm with mottled lucencies in the left upper quadrant. A CT confirmed a gastric bezoar within the stomach and small bezoars in the distal duodenum. She underwent upper endoscopy which showed a black hair bezoar. After spending 2 hours with multiple passes, less than 25% was removed and was referred for surgery. Two masses of hair 17 × 5 × 5 cm and 12 × 10 × 6 cm were removed via gastrotomy and a 6.5 × 3 × 3 cm was removed via ileal enterotomy. Results: DISSCUSSION: The term “bezoar” comes from the Arabic “badzhar” or the Persian “pahnzahr”, both meaning counterpoison or antidote. They are indigestible foreign body masses in the GI tract. They are classified into five types: phytobezoar, trichobezoar, pharmacobezoar, lactobezoar, and foreign body bezoars. Trichobezoar is seen in females less than 30 years of age. Ingestion of hair, (trichophagia), carpet, and clothing fiber are commonly implicated. They become trapped in the gastric folds forming a mass with symptoms of early satiety, weight loss, abdominal pain, and leading to obstructive symptoms. Plain radiographs and CT may be diagnostic, but endoscopy still remains the gold standard. Many approaches have been described such as enzymatic dissolution, to endoscopic removal with advanced instrumentation. Surgical removal via gastrotomy allows it to be removed in its entirety. Conclusion: CONCLUSION: Our case suggests that although endoscopic advances have been made, and success has been accomplished by some, their superiority to conventional techniques is still lacking. Gastrotomy should be considered over the tedious and time consuming endoscopic attempts. More ever, the patient should have psychiatric follow up to prevent recurrence, which our patient did not have, after her first episode.

Obstrucción intestinal causada por Tricobezoar: Síndrome de Rapunzel

Rapunzel syndrome or gastrointestinal trichobezoar is caused by hair ingestion. The diagnosis may be suspected in young females with important weight loss, who deny hair eating. We report a 16 year-old female consulting in the emergency room for abdominal pain. She was subjected to an exploratory laparotomy and a big mass was palpated in the stomach. A gastrostomy and enterostomy were performed and a 17 x 6 x 5 cm trichobezoar was extracted. The patient had an uneventful postoperative outcome and was derived to Psychiatry.

Intestinal obstruction by trichobezoars in five cats

Between 1997 and 1999, five domestic crossbred cats (four long haired, one short haired) presented with a palpable abdominal mass and were shown to have small intestinal trichobezoars at laparotomy or necropsy. Hair balls were associated with partial or complete intestinal obstruction and were situated in the proximal jejunum to distal ileum. In four cats obstructions were simple, while the remaining cat had a strangulating obstruction. Three of the cats were 10 years or older, and two were less than 4 years. In the three older cats abdominal neoplasia was suspected and investigations were delayed or declined in two of these cats because of a perceived poor prognosis. Predisposing factors identified in this series of cats included a long-hair coat, flea allergy dermatitis, inflammatory bowel disease and ingestion of non-digestible plant material. This report shows that the ingestion of hair is not always innocuous and that intestinal trichobezoars should be considered in the differential diagnoses of intestinal obstruction and intra-abdominal mass lesions, particularly in long-haired cats.