Tricobezoar retal: relato de um caso raro na literatura / Rectal trichobezoar: report of a rare case in literature

O bezoar compreende o acúmulo de substâncias não-digeríveis (folhas, pêlos, pedras, produtos lácteos, medicamentos, entre outros) no trato digestório. Sua importância deve-se ao quadro clínico por vezes inespecífico e às complicações que podem surgir. Apresentamos aqui o caso de uma paciente de 62 anos atendida no serviço de Cirurgia Oncológica com quadro de um mês de evolução e suspeita inicial de neoplasia colorretal. Exames complementares não elucidaram o diagnóstico, que só foi feito após abordagem cirúrgica por laparotomia exploratória. Após a mesma, a paciente evoluiu com piora do estado geral e foi transferida para a UTI do hospital, falecendo devido a complicações septicêmicas. Esse caso demonstra as dificuldades para se chegar nesse diagnóstico e que o atraso pode resultar em complicações letais para o paciente.

Bezoar is a foreign body in the digestive tract originated from ingestion of non-digestible substances (leaves, hair, rocks, milk products, drugs, etc). Undetermined clinical signs and severe complications make it an important diagnosis. We report the case of a 62-year-old female patient who was seen at the oncological surgery department of Santa Casa de Misericórdia de Fortaleza. The patient reported having low gastrointestinal symptoms for a month. Colorectal neoplasia was initially suspected. Blood and image diagnostic tests were not elucidative. The diagnosis was just confirmed after surgical approach. The patient had a poor postoperative follow-up and died after complications of septicemia. This case demonstrates the difficulties to confirm such diagnosis and the lethal complications caused by diagnosis delay.

Tricobezoar na infância: relato de três casos e revisão da literatura / Trichobezoar in children: report of three cases and review of literature

Tricobezoares são corpos estranhos gástricos compostos por cabelos dos próprios pacientes. São mais comuns em crianças, principalmente do sexo feminino. Cursam freqüentemente com sintomas gastrintestinais como dor abdominal, náuseas, vômitos, anorexia, perda de peso e plenitude pós-prandial. Massa epigástrica, alopécia e antecedentes de tricofagia podem estarpresentes. O tratamento de eleição é o cirúrgico, acompanhado de tratamento psiquiátrico. Este trabalho tem como objetivo relatar três casos de pacientes com tricobezoar gástrico e realizar uma revisão da literatura. Todos os casos deste estudo eram de crianças dosexo feminino. Dois pacientes cursaram com quadro de suboclusão intestinal, apresentando dor abdominal evômitos. Em um caso havia dor abdominal não acompanhada por vômitos. Todos apresentaram antecedentes de tricofagia, bem como massa epigástrica palpável. Um com áreas de alopécia. O principal examede imagem empregado foi a seriografiaesofagogastroduodenal. Todos foram submetidos a tratamento cirúrgico mediante gastrotomia e encaminhados para serviço de psicologia, com boaevolução clínica.

Trichobezoars are concretions of ingested hair that most often lodge in the stomach. They are commonlyseen in young girls with psychiatric disorders. Upper gastrointestinal symptoms usually are progressive andmay include abdominal pain, nausea and vomiting, early satiety, weight loss, bloating, diarrhea or constipation. Ahistory of tricophagia is common. Physical examination may include the presence of nontender palpable massand bald spot. Gastric trichobezoars require removal through an anterior gastrotomy. Postoperatively, psychiatric intervention is often appropriate. The purpose of this study was to describe three cases of patients with gastric trichobezoar and make a review of literature. All patients studied were yo ung girls. Two patients presented abdominal pain and vomiting. In one case there was abdominal pain without vomiting. All cases presented tricophagia and palpable mass. One had bald spot. Barium contrast study was the most beneficial in the diagnosis. In our cases, bezoars were removed easily via single gastrotomy. Postoperatively they were evaluated by psychology. The remainder of their hospital course wasunremarkable.

Bezoar gástrico como complicación de banda gástrica en manejo de obesidad mórbida: caso clínico / Gastric bezoar as complication of gastric banding: report of one case

Laparoscopic adjustable gastric banding (LAGB) is used for the management of morbid obesity. Phytobezoars are rarely reported as a complication of this operation and are usually extracted by endoscopic means. We report a 48 year-old male subjected to a gastric banding, that consulted for progressive dysphagia, six months after the operation. A barium meal x-ray examination demonstrated the presence of a bezoar that was dissolved in one week using papain. A control barium meal confirmed the disappearance of the bezoar.

Gastric trichobezoar presenting as gastric outlet obstruction--a case report.

Trichobezoars are impactions of swallowed hairs in the stomach and occasionally in the intestine. They occur in emotionally disturbed, depressed, or mentally retarded patients who have trichotillomania and trichophagia. Removal of gastric trichobezoar by open surgery (gastrotomy) is a standard approach. Psychiatric follow-up is needed to diminish the recurrence of trichotillomania and trichophagia. Here, we report a case of large gastric trichobezoar presenting as gastric outlet obstruction in a 13-years-old girl. She was treated with open surgical extraction of the bezoar and behavioral therapy.

Small bowel obstruction in children due to persimmon phytobezoars

To present the clinical picture of small bowel obstruction caused by Persimmon phytobezoars in children of Hazara [Northern Pakistan]. Design: Descriptive case series. Place and Duration of Study: Three general surgical units of Ayub Teaching Hospital, Abbottabad from November 1998 to March 2003. Patients and Nineteen children were managed for small bowel obstruction due to persimmon phytobezoars. The age, gender, season at the time of presentation, history of persimmon ingestion, symptoms, signs, site of obstruction, operative procedure and outcome were analyzed. There were 15 males and 4 females with ages ranging from 4-11 years [mean 7 years]. All presented in winter with a positive history of persimmon ingestion. All had signs and symptoms and evidence of small bowel obstruction on plain abdominal x-rays. At laparotomy, ileum was the commonest site of obstruction. Milking of bezoars into caecum was performed in 17 patients while 2 patients required enterotomy for removal of bezoars. Complications occurred in 4 patients. There was no mortality.Small bowel obstruction in children due to persimmon phytobezoars is uncommon. However, it should be considered pre-operatively as a possible cause of intestinal obstruction in winter in children who have access to the fruit. Laparotomy should be performed for persistent obstruction or signs of strangulation

Obstrucción intestinal por bezoares de naturalesa infrecuente: presentación de dos casos y revisión de la literatura / Intestinal obstruction by bezoars of un frequent origin: presentation of 2 cases and review of the literature

Reportamos dos casos quirúrgicos de obstrucción intestinal causados por bezoares del intestino delgado. El primero en un paciente femenina de 63 años, alcohólica, cuya sintomatología comienza en 48 horas después de ingerir abundante cantidad de licor y embutidos (chorizos). Se le practica laparotomía exploradora y se obtiene por enterotomía un bezoar del material plástico. El segundo caso, una paciente de 73 años cuyo cudro clínico fue atendido 24 horas por copiosa ingesta de higos. El hallazgo operatorio fue un fitobezoar intestinal. Se discuten los factores epidemiológicos y etiológicos, y el manejo de los pacientes con estos cuerpos extraños

Clinical profile of trichotillomania.

Twenty-four cases of trichotillomania attending psychiatry outpatient department and child guidance clinic at Kalawati Saran Children's and Smt Sucheta Kriplani Hospitals over a period of 2 years from July, 1985 to November 1987 were studied. Females (66.7%) outnumbered the males (33.3%). Majority of cases belonged to age group 6-10 years (54.2%) and nuclear family (68.5%). Nail-biting (25.0%) was the commonest associated neurotic trait, followed by enuresis (20.9%), temper-tantrum (12.5%), etc. A past history of hysterical fits and neurotic depression was found in 3 cases (12.5%) and 2 cases (8.3%) respectively. Family history of neurosis was seen in mothers and fathers of 20.9% and 12.5% cases respectively. Trichobezoars and trichophytobezoars were found in 6 cases (25.0%) and 3 cases (12.5%) respectively. Majority of patients of trichobezoars presented with vague complaints like heaviness in the stomach (55.6%), inability to gain weight (44.4%), etc, while 22.2% cases were asymptomatic and detected only on screening.

Obstruçäo intestinal por Fitobezoar: apresentaçäo de dois casos / Intestinal obstruction by fithobezoar: report of 2 cases

Apresentam-se, neste trabalho, dois casos de obstruçäo intestinal por Fitobezoar; em um deles näo houve cirurgia gástrica prévia, o que é pouco comum na patologia em questäo. Fazem-se algumas consideraçöes sobre a etiopatogenia, os aspectos clínicos e diagnósticos, bem como sobre a terapia a que se procedeu

Bezoar gástrico producido por pegamento sintético / Gastric bezoar due to synthetic glue

Se presenta el caso clínico de un paciente psicópata de 19 años de edad, con antecedentes de drogadicción que desarrolló un Bezoar Gástrico por la ingestión de una resina sintética del tipo de pegamentos de contacto que deterioró su estado general. El caso se diagnosticó clínica y radiológicamente y fue resuelto por cirugía. Se trata de un caso raro no descrito hasta ahora en la literatura médica