Recurrent Gastric Trichobezoars - A Case Report and Literature Review
Keywords:
bezoar, trichobezoar, trichotillomania, trichophagiaAbstract
A trichobezoar is a hairball usually confined to the stomach of almost exclusively young females, and typically results from the patient pulling out her hair (trichotillomania) and swallowing it (trichophagia). We describe a case of recurrent gastric trichobezoars in a young female with trichophagia who presented at the ages of 18, 21, and 25 years old with similar complaints of epigastric discomfort, early satiety, loss of appetite, intermittent nausea, and very foul smelling burps. At each presentation, endoscopy revealed a gastric trichobezoar and endoscopic fragmentation efforts were unsuccessful. The first two trichobezoars were removed via laparoscopic gastrotomy. The most recent and largest of the three trichobezoars required laparotomy secondary to dense adhesions. The patient and her parents persistently refused psychiatric consultation and outpatient follow-up which is an integral aspect of preventing trichobezoar recurrence.
References
Andrus CH, Ponsky JL. Bezoars. Classification, Pathophysiology, and Treatment. Am J Gastroenterol. 1988;83:476-478.
Sanders M. Bezoars: From Mystical Charms to Medical and Nutritional Management. The Practical Gastroenterology Journal. http://www.medicine.virginia.edu/clinical/departments/medicine/divisi ons/digestive-health/nutrition-support-team/nutrition- articles/practicalgasto1.04.pdf, 10/10/2015.
Dubose TM, Southgate WM, Hill JG. Lactobezoars: A patient series and literature review. Clin Pediatr. 2001;40:603-606.
Phillips MR, Zaheer S, Drugas GT. Gastric Trichobezoar: Case Report and Literature Review. Mayo Clin Proc. 1998;73:653-656.
Kim JS, Nam CW. A Case of Rapunzel Syndrome. Pediatr Gastroenterol Hepatol Nutr. 2013;16:127-130.
Goldman RD, Schachter P, Katz M, Bilik R, Avigad I. A bizarre bezoar: case report and review of the literature. Pediatr Sur Int. 1998;14:218-219.
Frey AS, McKeeM, King RA, Martin A. Hair apparent: Rapunzel syndrome. Am J Psychiatry. 2005;162:242-248.
Gorter R.R., Kneepkens C.M.F., Mattens E. C. J.L., Aronson D. C., Heij H.A. Management of trichobezoar: case report and literature review. Pediatr Surg Int. 2010;26:457-463.
Kirpinar I, Kocacenk T, Kocer E, Memmi N. Recurrent trichobezoar due to trichophagia: a case report. Gen Hosp Psychiatry. 2013;35:439- 441.
Gonuguntla V, Joshi DD. Rapunzel syndrome: A comprehensive review of an unusual case of trichobezoar. Clin Med Res. 2009;7:99- 102.
Munday W, Zhang X. Proton pump inhibitor responsive esophageal eosinophilia, a distinct disease entity? World J Gastroenterol. 2014;20:10419-10424.
Straumann A, Aceves SS, Blanchard C, et al. Pediatric and adult eosinophilic esophagitis: similarities and differences. Allergy. 2012;67:477–490.
Tiwary SK, Kumar S, Khanna R, Khanna AK. Recurrent Rapunzel Syndrome. Singapore Med J. 2011;52:e128-130.
Crawley AJ, Guillerman RP. Rapunzel Syndrome. Pediatr Radiol. 2010;40:100.
