Trichobezoar: A Rare Cause of Protein-losing Enteropathy

Abstract

Protein-losing enteropathy (PLE) is caused by protein loss through the gastrointestinal tract which results in hypoalbuminemia. The most common causes of PLE in children include cow milk protein allergy, celiac disease, inflammatory bowel disease, hypertrophic gastritis, intestinal lymphangiectasia, and right-sided heart dysfunction. We present a case of a 12-year-old male with bilateral lower extremity edema, hypoalbuminemia, elevated stool alpha-1-antitrypsin, and microcytic anemia. He was found to have a trichobezoar in the stomach extending to the jejunum, an unusual cause of PLE. The patient underwent an open laparotomy and gastrostomy to remove the bezoar. Follow-up confirmed resolution of hypoalbuminemia.

FIGURE 1.

Coronal (A) and sagittal oblique (B) contrast-enhanced computerized tomography (CT) images of the abdomen and pelvis revealed a large, mixed attenuation mass distending the gastric lumen (white arrows) and extending through the pylorus (white arrowheads) into the proximal duodenum (black arrows). Coronal (C) and sagittal oblique (D) contrast-enhanced CT images of the abdomen and pelvis revealed a large, mixed attenuation mass distending the gastric lumen (white arrows) and extending through the pylorus (white arrowheads) into the proximal duodenum (black arrows). (E) Surgically extracted trichobezoar forming a cast of stomach, duodenum, and jejunum.