Multidisciplinary treatment of massive trichobezoar caused an acute gastric outlet obstruction

Abstract

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.

Keywords

• trichobezoar
• gastrotomy
• trichophagia
• emotional disturbance