Small Bezoars Research Articles

HUNGRY FOR HAIR - RAPUNZEL SYNDROME: A CASE REPORT

Rapunzel syndrome is a rare condition where bezoar made of ingested hair is found in stomach or intestine. Incidence is <18% (In patients with trichotillomania). Small bezoars can be removed endoscopically whereas large ones require surgery. The medical & psychiatric treatment of Trichotillomania should not be underestimated & early diagnosis & treatment play's a major role in saving patient's life. We describe a case of 14yr old girl with Trichophagia and Trichotillomania who presented to our surgery op with history of pain abdomen and vomiting. Clinical examination & Investigations showed the presence of a Trichobezoar causing Gastric Outlet Obstruction requiring immediate surgical intervention

TRICHOBEZOARS IN CHILDREN ON THE EXAMPLE OF CLINICAL CASES

The formation of trichobezoars is a rareclinical condition that develops primarily as a result ofmental illness. Literature data indicate that trichobezoarsare most often found in children. The presence of a bezoarcan lead to serious complications such as erosion of thestomach lining, peptic ulcer disease, and even perforation ofthe stomach or small intestine. Treatment options for gastrictrichobezoars range from endoscopic removal, dissolution,and mechanical hydrojet crushing of small bezoars tosurgical removal of giant bezoars. The presented clinicalcases prove the danger caused by trichobezoar. Cases ofthe formation of a trichobezoar with a clinic of intestinalobstruction in an adolescent girl, and a trichobezoar ofthe blind end of the esophagus and a clinic of respiratoryfailure in a small child with a congenital malformation ofthe esophagus are described. This pathology can occur atany age, have an atypical clinical picture and, in case ofuntimely treatment, lead to tragic consequences. In addition,it is necessary to use a multidisciplinary approach to themandatory provision of psychological (or psychiatric) carefor children, to teach parents to take care of a child who isprone to trihotilomaniа and trichophagia.

Effects of the Stage of Maturity of Merremia emarginata on Initiating Formation of Phytobezoars in Sheep in North Kordofan, Sudan

Thirty castrated rams of Sudanese Desert sheep breed, Hammari ecotype at 1.5-2 years were divided into five groups each with six animals. The animals were weighed prior commencement of the trial (30+ 0.500 kg) and once every week for ninety days. They were vaccinated against diseases endemic to the study area, drenched with a broad spectrum anthelementic and ear-tagged to facilitate identification during treatments. The rams were individually penned provided with drinking and feeding troughs. Rumen liquor was taken for in vitro dry matter and organic matter digestibility. During the trial period, animals were diagnosed by palpation for phytobezoars. At the end of the experiment rams were slaughtered, the site of formation of ball-shaped bodies determined, size and weight were also determined. Data was analyzed via analysis of variance. The results indicated increased feed intake for the group that was on a ration free of Merremia emarginata and those consumed rations with the plant biomass at vegetative growth and at flowering stages. At early and late maturity stages, feed intake decreased and phytobezoars were formed. The bezoars differed in weight and size, where larger and heavier ones were retained from the rumen, medium irregular ones from omasum and small bezoars from the reticulum. It was concluded that M emarginata biomass could initiate phytobezoars' formation at seed formation stage or when it reached late maturity stage. Palpation showed presence of bezoars after continuous ingestion of feed containing the plant biomass. It was recommended that more studies be conducted to determine the minimal amount of the biomass under study to initiate phytobezoars' formation.

A Case Report

Rapunzel syndrome is very rare gastric foreign bodies that occur in children. It is a severe condition of a gastric trichobezoar with a long tail that passes into the small intestine. Here, we present the case of an 8-year-old girl with Rapunzel syndrome due to a very large (7 × 7 × 30 cm) gastric trichobezoar. The patient had trichotillomania and trichophagia for 1 year prior to presentation. Ideally, small bezoars are removed through a minimally invasive method, such as endoscopic fragmentation. However, large trichobezoars, including those in Rapunzel syndrome, can only be managed with open surgical extraction, despite the large scars that may result.We report a case of Rapunzel syndrome with a large bezoar that was surgically removed after it was endoscopically cauterized with argon plasma. Endoscopic precutting was used to effectively reduce the size of the bezoar.

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.

GIANT GASTRIC TRICHOBEZOAR

SUMMARYBezoars are relatively common foreign body lesions of the stomach and intestine. Small bezoars can be treated using non‐surgical methods, but large bezoars usually require open surgery. Occasionally they are giant‐sized and may mimic an intra‐abdominal mass clinically. We present the case of a 24‐year‐old woman with a giant gastric trichobezoar treated by open surgery; treatment methods are discussed.