Volume 4, Issue 2, December 2020, Page: 45-49
Diagnosis and Surgical Extraction of Large Gastric Trichobezoars: A Single Center Study of Two Cases
Tulika Saggar, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
Varun Saggar, Department of Surgery, Lord Mahavir Civil Hospital, Ludhiana, Punjab, India
Received: Jul. 5, 2020;       Accepted: Jul. 17, 2020;       Published: Aug. 4, 2020
DOI: 10.11648/j.ijg.20200402.14      View  203      Downloads  31
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.
Trichobezoar, Trichotillomania, Gastrotomy, Case Report
To cite this article
Tulika Saggar, Varun Saggar, Diagnosis and Surgical Extraction of Large Gastric Trichobezoars: A Single Center Study of Two Cases, International Journal of Gastroenterology. Vol. 4, No. 2, 2020, pp. 45-49. doi: 10.11648/j.ijg.20200402.14
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Carr JR, Sholevar EH, Baron DA. Trichotillomania and trichobezoar: a clinical practice insight with report of illustrative case. J Am Osteopath Assoc 2006; 106 (11): 647-652 [PMID: 17192451].
Diefenbach GJ, Reitman D, Williamson DA. Trichotillomania: a challenge to research and practice. Clin Psychol Rev 2000; 20 (3): 289-309 [PMID: 10779896 DOI: 10.1016/s0272-7358(98)00083-x].
Kuntoji V, Kudligi C, Bhagwat PV, Asati DP, Bansal A. The tricky "trichs" in dermatology! Indian J Dermatol Venereol Leprol 2018; 84 (1): 109-113 [PMID: 29243672 DOI: 10.4103/ijdvl.IJDVL_1019_16].
Shorter E. A historical dictionary of psychiatry. New York: Oxford University Press; 2005.
Gokbulut V, Kaplan M, Kacar S, Akdogan Kayhan M, Coskun O, Kayacetin E. Bezoar in upper gastrointestinal endoscopy: A single center experience. Turk J Gastroenterol 2020; 31 (2): 85-90 [PMID: 32141815 PMCID: 7062142 DOI: 10.5152/tjg.2020.18890].
Mirza MB, Talat N, Saleem M. Gastrointestinal trichobezoar: An experience with 17 cases. J Pediatr Surg 2020 [PMID: 32467033 DOI: 10.1016/j.jpedsurg.2020.04.020].
Coulter R, Antony MT, Bhuta P, Memon MA. Large gastric trichobezoar in a normal healthy woman: case report and review of pertinent literature. South Med J 2005; 98 (10): 1042-1044 [PMID: 16295823 DOI: 10.1097/01.smj.0000182175.55032.4a].
Pérez E, Ramón Sántana J, García G, Mesa J, Ramón Hernández J, Betancort N, Núñez V. Perforación gástrica en adulto por tricobezoar (síndrome de Rapunzel). Cirugía Española 2005; 78 (4): 268-270 [DOI: https://doi.org/10.1016/S0009-739X(05)70931-3].
Ventura DE, Herbella FA, Schettini ST, Delmonte C. Rapunzel syndrome with a fatal outcome in a neglected child. J Pediatr Surg 2005; 40 (10): 1665-1667 [PMID: 16227005 DOI: 10.1016/j.jpedsurg.2005.06.038].
Kwok AMF. Trichobezoar as a cause of pediatric acute small bowel obstruction. Clin Case Rep 2020; 8 (1): 166-170 [PMID: 31998509 PMCID: 6982476 DOI: 10.1002/ccr3.2576].
Al-Osail EM, Zakary NY, Abdelhadi Y. Best management modality of trichobezoar: A case report. Int J Surg Case Rep 2018; 53: 458-460 [PMID: 30567068 PMCID: 6275210 DOI: 10.1016/j.ijscr.2018.11.030].
Eng K, Kay M. Gastrointestinal bezoars: history and current treatment paradigms. Gastroenterol Hepatol (N Y) 2012; 8 (11): 776-778 [PMID: 24672418 PMCID: PMC3966178].
Iwamuro M, Okada H, Matsueda K, Inaba T, Kusumoto C, Imagawa A, Yamamoto K. Review of the diagnosis and management of gastrointestinal bezoars. World J Gastrointest Endosc 2015; 7 (4): 336-345 [PMID: 25901212 PMCID: PMC4400622 DOI: 10.4253/wjge.v7.i4.336].
Paschos KA, Chatzigeorgiadis A. Pathophysiological and clinical aspects of the diagnosis and treatment of bezoars. Ann Gastroenterol 2019; 32 (3): 224-232 [PMID: 31040619 PMCID: PMC6479654 DOI: 10.20524/aog.2019.0370].
Sehgal VN, Srivastava G. Trichotillomania +/- trichobezoar: revisited. J Eur Acad Dermatol Venereol 2006; 20 (8): 911-915 [PMID: 16922936 DOI: 10.1111/j.1468-3083.2006.01590.x].
Frey AS, McKee M, King RA, Martin A. Hair apparent: Rapunzel syndrome. Am J Psychiatry 2005; 162 (2): 242-248 [PMID: 15677585 DOI: 10.1176/appi.ajp.162.2.242].
Kement M, Ozlem N, Colak E, Kesmer S, Gezen C, Vural S. Synergistic effect of multiple predisposing risk factors on the development of bezoars. World J Gastroenterol 2012; 18 (9): 960-964 [PMID: 22408356 PMCID: PMC3297056 DOI: 10.3748/wjg.v18.i9.960].
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). 2000, Washington.
França K, Kumar A, Castillo D, Jafferany M, Hyczy da Costa Neto M, Damevska K, Wollina U, Lotti T. Trichotillomania (hair pulling disorder): Clinical characteristics, psychosocial aspects, treatment approaches, and ethical considerations. Dermatol Ther 2019; 32 (4): e12622 [PMID: 30152568 DOI: 10.1111/dth.12622].
Duke DC, Keeley ML, Geffken GR, Storch EA. Trichotillomania: A current review. Clin Psychol Rev 2010; 30 (2): 181-193 [PMID: 19926375 DOI: 10.1016/j.cpr.2009.10.008].
Naik S, Gupta V, Naik S, Rangole A, Chaudhary AK, Jain P, Sharma AK. Rapunzel syndrome reviewed and redefined. Dig Surg 2007; 24 (3): 157-161 [PMID: 17476105 DOI: 10.1159/000102098].
Otten MJ, Charehbili A, Duinhouwer LE. Small-Bowel Obstruction Secondary to a Trichobezoar in a Meckel's Diverticulum in a Patient with Rapunzel Syndrome. J Gastrointest Surg 2020; 24 (5): 1220-1221 [PMID: 31745891 DOI: 10.1007/s11605-019-04448-x].
Fallon SC, Slater BJ, Larimer EL, Brandt ML, Lopez ME. The surgical management of Rapunzel syndrome: a case series and literature review. J Pediatr Surg 2013; 48 (4): 830-834 [PMID: 23583142 DOI: 10.1016/j.jpedsurg.2012.07.046].
Antunes H, Barroso C, Faria C, Correia-Pinto J. Images in paediatrics: Rapunzel syndrome: the pathway for a prompt diagnosis. Arch Dis Child 2020; 105 (3): 298 [PMID: 30509953 DOI: 10.1136/archdischild-2018-315910].
Castle SL, Zmora O, Papillon S, Levin D, Stein JE. Management of Complicated Gastric Bezoars in Children and Adolescents. Isr Med Assoc J 2015; 17 (9): 541-544 [PMID: 26625542].
Placone N, Mann S. A Trichobezoar of Gastric Proportions. Clin Gastroenterol Hepatol 2020; 18 (2): e18 [PMID: 30342915 DOI: 10.1016/j.cgh.2018.10.023].
Zmudzinski M, Hayashi A. Laparoscopic removal of massive pediatric gastric trichobezoars: A brief report. Am J Surg 2020; 219 (5): 810-812 [PMID: 32063342 DOI: 10.1016/j.amjsurg.2020.01.048].
Gupta A, Mittal D, Srinivas M. Gastric Trichobezoars in Children: Surgical Overview. Int J Trichology 2017; 9 (2): 50-53 [PMID: 28839386 PMCID: PMC5551305 DOI: 10.4103/ijt.ijt_38_17].
Wang CK, Chen JC, Chang FY. A giant trichobezoar in a young girl: A case report. Pediatr Neonatol 2020; 61 (2): 241-242 [PMID: 31629666 DOI: 10.1016/j.pedneo.2019.09.011].
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