Endoscopic shaving of hair in a gastric bypass patient with a large bezoar

Abstract

Trichotillomania can be associated with the formation of trichobezoars (hair ball) usually located in the stomach. Trichobezoars may lead to complications including bowel obstruction, and perforation. Patients with a history of diabetes, certain psychiatric disorders, prior gastric surgery and poor mastication ability are at an increased risk of developing bezoars. We are presenting a case of patient who suffered from a large, recurrent trichobezoar, who had a history of gastric bypass surgery as well as trichotillophagia. The endoscopic method used to remove the large bezoar will also be discussed. We have reviewed the cases published, in which patients developed bezoars after undergoing gastric bypass surgery. The purpose of this study is to raise awareness among clinicians that patients with certain psychiatric issues who had prior gastric surgeries, are at eminent risk of bezoar formation. A multidisciplinary approach including cognitive behavioural therapy, dietary education and pharmacotherapy should be taken to prevent complications.

Keywords: Gastrointestinal Surgery; eating disorders; endoscopy; stomach and duodenum.

Figure 1 (A)

CT scan of abdomen axial view showing stomach distension with intraluminal heterogeneous mass with air trapped in the mass. (B) CT scan of abdomen coronal view showing intraluminal mass with interspersed gas in stomach (red arrow).

Figure 2 (A)

Endoscopy showing large hair mass obstructing the lumen. (B) Underlying mucosa of stomach after removal of bezoar

Figure 3

Trichobezoar removed with plastic clip (red arrow).