Trichobezoar-induced gastric outlet obstruction in a 17-year-old girl: a case report

Abstract

Gastric outlet obstruction (GOO) is an uncommon, yet potentially severe, condition arising from multiple causes, including ingesting foreign bodies. The formation of plastic bezoars or trichobezoars due to swallowing indigestible materials remains a rare cause, especially among children exhibiting pica behavior (Vaughan et al. The Rapunzel syndrome: an unusual complication of intestinal bezoar. Surgery 1968;63:339-43). We present a 17-year-old female with a known history of pica who presented with symptoms of abdominal pain, persistent vomiting, and inability to tolerate oral intake. Examination revealed a palpable mass in the abdomen. Imaging and endoscopic evaluations revealed a large trichobezoar occupying the stomach and extending into the first part of the duodenum, obstructing the gastric outlet. Endoscopic attempts at removal were unsuccessful due to the bezoar's size and extension, necessitating an open surgical procedure. The patient experienced an uneventful recovery and was referred for psychiatric follow-up to manage her pica and prevent recurrence. This case emphasizes the critical need for timely identification and a comprehensive treatment approach. It involves both surgical removal and psychiatric care to address the underlying behavioral disorder and reduce the risk of recurrence in trichobezoar-related GOO.

Keywords: Rapunzel syndrome; bowel obstruction; trichobezoar; trichophagia.

Figure 1

(a–c) Computed tomography (CT) revealed a distended stomach with large endoluminal mass of heterogeneous material likely representing trichobezoar. Mucosal hyper-enhancement of the stomach.

Figure 2

(a and b) Upper gastroscopy revealed a trichobezoar at the lower of gastroesophageal junction and within the stomach.

Figure 3

(a–c) Revealed gastrostomy on the anterior stomach wall. A large hair bezoar extending from the stomach into the pylorus was carefully extracted intact.