Unusual trichobezoar of the stomach and the intestine: a case report

Abstract

Introduction: Trichobezoars are an infrequent form of bezoar found in the stomach or intestine, created from ingested hair. This condition has been well described in the surgical literature, but less reported in psychiatry.

Case presentation: We describe the case of an 18-year-old Middle Eastern Caucasian woman with trichotillomania who presented to our emergency department with a history of central abdominal pain associated with vomiting and constipation for five days. An examination showed a trichobezoar requiring emergent surgical intervention, and indicating the need for psychiatric treatment. The trichobezoar was treated successfully by laparotomy.

Conclusion: The medical and psychiatric sequelae of trichotillomania should not be underestimated, and early diagnosis and treatment is of utmost importance to save the patient's life and prevent recurrence. Although laparotomy is still considered an excellent option, pharmacotherapy and behavioral assessment play a useful role in patient management. Our case highlights the fundamental concept of a holistic approach rather than only treating the symptoms, by considering factors such as genetic influences to understand the disease.

Figure 1

Plain X-ray of the abdomen showing a well-defined, rounded soft tissue density mass, in the central abdominal region with calcification (arrows).

Figure 2

Upright plain abdominal X-ray demonstrating a small bowel obstruction. Note the presence of multiple air fluid levels.

Figure 3

Removal of the trichobezoar from the stomach.

Figure 4

Removal of trichobezoar revealed two masses taking the shape of the stomach and ileum.