Jejunal trichobezoar causing small bowel perforations in a child: A case report

Abstract

Introduction: Trichobezoar is a rare gastrointestinal foreign body predominantly affecting young females. While typically confined to the stomach, migration can result in severe complications, including obstruction and perforation. Case presentation: A previously healthy 5-year-old female presented with acute abdominal pain, vomiting, and intolerance to oral intake. Initial imaging, including ultrasound and MRI, was inconclusive, but a subsequent CT scan revealed duodenal intussusception and significant gastric content. After endoscopy, the patient developed peritonitis, necessitating emergency surgery. Fourteen full-thickness perforations were identified along the mesenteric side of the jejunum, caused by a migrating trichobezoar. Ninety centimeters of small bowel was resected during the initial surgery, followed by two additional procedures for abdominal washout and resection of 15 cm of non-viable bowel. Pathology confirmed the diagnosis of trichobezoar. The patient recovered fully, tolerating oral feeds without recurrence of symptoms, and was discharged after 28 days of hospitalization. Conclusions: Trichobezoars of the small bowel are rare but should always be included in the differential diagnosis of children presenting with acute abdominal pain, even in the absence of a psychiatric history.

Keywords

• Trichobezoar
• Bowel perforation
• Case report
• Rapunzel syndrome
• Jejunal perforation