Management of trichobezoar: case report and literature review

Abstract

Trichobezoars (hair ball) are usually located in the stomach, but may extend through the pylorus into the duodenum and small bowel (Rapunzel syndrome). They are almost always associated with trichotillomania and trichophagia or other psychiatric disorders. In the literature several treatment options are proposed, including removal by conventional laparotomy, laparoscopy and endoscopy. We present our experience with four patients and provide a review of the recent literature. According to our experience and in line with the published results, conventional laparotomy is still the treatment of choice. In addition, psychiatric consultation is necessary to prevent relapses.

Fig. 1

Rapunzel syndrome (patient #1)

Fig. 2

Rapunzel syndrome: after removal: the cast of the stomach with the tail located in the jejunum (patient #1)

Fig. 3

MRI (transversal view) in case #4: symptoms and signs (upper abdominal mass, confirmed with ultrasound) were interpreted as suggestive of a malignant process. MRI revealed the presence of an intraluminal mass in the stomach