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. 2022 Feb:91:106782.
doi: 10.1016/j.ijscr.2022.106782. Epub 2022 Jan 22.

Trichobezoar: A case report of a double gastric and ilial localization revealed by an occlusion

Mohamed Ben Khalifa  1 , Mossaab Ghannouchi  2 , Karim Nacef  2 , Asma Chaouch  2 , Mohamed Sellami  2 , Moez Boudokhane  2
Affiliations

Trichobezoar: A case report of a double gastric and ilial localization revealed by an occlusion

Mohamed Ben Khalifa et al. Int J Surg Case Rep. 2022 Feb.

Abstract

Introduction and importance: A bezoar is an agglutination of ingested materials forming an indigestible and insoluble mass inside the gastrointestinal tract. Trichobezoars formed by ingested hair are rare. The stomach tends to be the typical location. In some cases there is an extension to the duodenum, jejunum or even to the colon and it is called Rapunzel syndrome.

Case presentation: We present a case of an occlusion due to double trichobezoars in 17 years old woman who underwent an extraction by enterotomy and gastrotomy.

Clinical discussion: Trichobezoar is a compact conglomeration of swallowed hair and makes up less than 6% of all bezoars. It appears in young women under 20 years of age who carry psychiatric or chronic metabolic diseases that can alter the behavioral balance. Physical examination is often poor in uncomplicated forms: forms without peritonitis or occlusion or hemorrhage or appendicitis or pancreatitis but it may reveal a well-limited, smooth, firm, and mobile epigastric mass. For uncomplicated forms or forms complicated by hemorrhage, the reference examination requested in the first line remains the esophagogastroduodenoscopy (EGD) which allows a dual role both diagnostic and therapeutic. Computed Tomography (CT) remains the preferred imaging modality requested urgently in case of an occlusion or peritonitis presentation. Endoscopic extraction represents the therapeutic approach for uncomplicated forms but surgical treatment remains the main therapeutic means of trichobezoar.

Conclusion: Trichobezoars are rare and present both diagnostic and therapeutic challenge. Laparotomy remains the most successful surgical treatment although laparoscopy currently appears to have promising results in expert hands. A post-operative pscychologic management is essential to correct psychobehavioral disorders of patients to prevent recurrence.

Keywords: Case report; Stomach; Surgery; Trichobezoar.

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Conflict of interest statement

No conflict of interest.

Figures

Fig. 1
Fig. 1
CT axial view showing the double location of bezoar: stomach (a), small bowel (b).
Fig. 2
Fig. 2
CT coronal view showing a bezoar in the stomach as outlined by contrast (star).
Fig. 3
Fig. 3
surgical extraction of the ileal trichobezoar.
Fig. 4
Fig. 4
A stomach-shaped trichobezoar.
Fig. 5
Fig. 5
trichobezoars of the stomach and ileum.
See this image and copyright information in PMC

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