Síndrome de Rapunzel asociado a perforación intestinal. Caso clínico / Rapunzel syndrome associated with intestinal perforation. Clinical case

Introducción. Los tricobezoares ocurren de forma frecuente en niñas y adolescentes, y se asocian a trastornos psicológicos como depresión, tricotilomanía o tricofagia. Caso clínico. Se presenta una paciente adolescente con síndrome de Rapunzel, con hallazgo adicional de perforación yeyunal debido al tricobezoar. Discusión. Dentro de las complicaciones de los tricobezoares se reporta invaginación intestinal (principalmente de yeyuno), apendicitis, obstrucción biliar, neumonía, pancreatitis secundaria y perforación, esta última como ocurrió en nuestra paciente. Conclusión. En pacientes mujeres adolescentes con dolor abdominal o abdomen agudo, se debe tener en cuenta el diagnóstico de síndrome de Rapunzel, así como sus probables complicaciones

Introduction. Trichobezoars occur frequently in young and adolescent girls, and are associated with psychological disorders such as depression, trichotillomania, or trichophagia. Clinical case. An adolescent patient with Rapunzel syndrome is presented, with an additional finding of jejunal perforation due to the trichobezoar. Discussion. Among the complications of trichobezoars, intussusception is reported (mainly of the jejunum), appendicitis, biliary obstruction, pneumonia, secondary pancreatitis, and perforation, the latter as occurred in our patient. Conclusion. In adolescent female patients with abdominal pain or acute abdomen, the diagnosis of Rapunzel syndrome should be taken into account, as well as its probable complications

El largo camino de la tricotilomania al síndrome de Rapunzel / The Long Road from Trichotillomania to Rapunzel Syndrome

Introducción: La tricotilomania, la tricofagia y el tricobezoar son afecciones entrelazadas e interconectadas. Estas deben tenerse en cuenta especialmente en féminas jóvenes que a menudo tienen una enfermedad psiquiátrica o trastorno social subyacente y es posible que la historia sea difícil de obtener. Objetivo: Presentar un caso portador de tricobezoar gástrico, por su baja incidencia en nuestro medio y a nivel mundial. Caso clínico: Paciente femenina de 12 años de edad, con antecedentes de retraso psicomotor, sin seguimiento o tratamiento previo. Acudió a consulta traída por su madre que aduce aumento de volumen en hemiabdomen superior de 5 años de evolución con pérdida de peso insidiosa. Los estudios radiológicos revelaron un tricobezoar gástrico que se corrobora, asociado a un síndrome de Rapunzel, en la laparotomía exploratoria. La paciente evolucionó satisfactoriamente y es seguida por grupo multidisciplinario. Conclusiones: Los bezoares gástricos son entidades poco frecuentes. Para el diagnóstico es necesario un alto índice de sospecha de conjunto con estudios radiográficos y/o endoscópicos. El tratamiento estará determinado por el tipo de bezoar, tamaño y consistencia. La opción quirúrgica es la más usada, con el consecuente seguimiento interdisciplinario para evitar recurrencias(AU)

Introduction: Trichotillomania, trichophagia and trichobezoar are intertwined and interconnected conditions. These should be considered, especially in young women who often have an underlying psychiatric illness or social disorder and possibly a history difficult to get. Objective: To report a case of gastric trichobezoar due to its low incidence in our environment and worldwide. Clinical case report: We report the case of a 12-year-old female patient with a history of psychomotor retardation, with no prior follow-up or treatment, who came to consult with her mother, complaining of increased volume in the upper abdomen, of 5 years of evolution with malignant weight loss. Radiological studies reveal a gastric trichobezoar that is corroborated, associated with Rapunzel syndrome, in the exploratory laparotomy. The patient evolved satisfactorily and a multidisciplinary group assisted her. Conclusions: Gastric bezoars are rare entities. Diagnosis requires high level of suspicion together with radiographic and/or endoscopic studies. The treatment will be determined by the type of bezoar, size and consistency. The surgical option is the most used, requiring interdisciplinary follow-up to avoid recurrences(AU)

Tricobezoar: reporte de caso / Case report: Trichobezoar

Reportamos el caso de una adolescente femenina que ingresa al Hospital Mario Catarino Rivas en San Pe- dro Sula con antecedente de tricofagia desde hace 5 años. Ingresa con historia de dolor abdominal epigás- trico de 3 meses de evolución con náuseas y vómitos de alimentos ocasionales junto a pérdida de aproxima- damente 6 kilogramos de peso en los últimos 3 meses. Paciente fue ingresada y se completaron estudios diagnosticándose tricobezoar gástrico con poste- rior intervención quirúrgica: laparotomía media supraumbilical accediendo al estómago sobre el cual se le realizó una gastrostomía antral de 6 cm de longitud por donde se extrae el bezoar en su to- talidad. Se cierra posteriormente la gastrotomía.

Trichotillomania masked by diffuse Alopecia Areata: A case report

@#An 11-year-old girl previously treated for tinea capitis presented a 3-month history of continuous decrease in hair density on the vertex, frontal, and parieto-temporal areas of the scalp. Hair pull test was negative. Trichoscopic findings showed black dots, micro-exclamation point hairs, regrowing vellus hair, and zigzag hairs. Histopathology showed CD3+ peribulbar lymphocytic infiltrates and occasional eosinophils around the anagen hair follicle consistent with a non-scarring alopecia. A diagnosis of diffuse alopecia areata was made. Patient was given methylprednisolone (0.5 mg/kg/day) for 2 weeks and noted marked increase in hair density except on focal areas of the scalp. Patient eventually admitted to occasional hair pulling. Trichoscopy revealed trichoptilosis, V-sign, tulip hairs, and multiple broken hairs of varying length while a second biopsy showed trichomalacia and pigment casts consistent with trichotillomania. In this case, where co-existence of alopecia areata and trichotillomania is considered to be uncommon, trichoscopy proved to be an important tool in differentiating hair disorders with similar presentation. Knowing key features of hair diseases can help elucidate the diagnosis when presented with an atypical case.

Síndrome de Rapunzel como complicación en una paciente lúpica / Rapunzel syndrome as a complication in a lupus patient

El lupus eritematoso sistémico es una enfermedad que causa un gran número de complicaciones de origen psicológico; estas pueden llevar a patrones inadecuados de conducta que pueden poner en riesgo la vida de los pacientes como el síndrome de Rapunzel. Se describen los elementos clínicos y diagnósticos de este síndrome mediante el caso de una paciente femenina de 25 años de edad, con diagnóstico de lupus eritematoso sistémico. Acude a consulta con manifestaciones clínicas e imagenológicas que permiten llegar al diagnóstico de síndrome de Rapunzel como complicación psicológica en el curso del lupus eritematoso sistémico. Se procede a realizar la intervención quirúrgica donde se halló una masa tumoral constituida por cabello humano. En la actualidad, la paciente se mantiene en seguimiento por las especialidades de reumatología, psiquiatría y psicología, y su recuperación y evolución han sido satisfactorias. El lupus eritematoso condiciona conductas que pueden ser perjudiciales para la salud de los pacientes. Es importante la identificación precoz de conductas como la tricotilomanía y el seguimiento psicológico especializado en pacientes con esta enfermedad(AU)

Systemic lupus erythematosus is a systemic disease that generates a large number of complications of psychological origin; these can lead to inappropriate behavior patterns that can be life-threatening for patients. To describe the clinical and diagnostic elements of Rapunzael syndrome. Clinical case: a 25-year-old female patient with a diagnosis of systemic lupus erythematosus who consulted with clinical and imaging manifestations that led to the diagnosis of Rapunzel syndrome as a psychological complication in the course of systemic lupus erythematosus. Lupus erythematosus conditions a series of behaviors that can be detrimental to the health of patients; early identification of behaviors such as trichotillomania and specialized monitoring in psychology in patients with this disease is important. The clinical evolution of the patient has been very favorable and her general condition has recovered(AU)

Skin picking treatment with the Rothbaum cognitive behavioral therapy protocol: a randomized clinical trial

Introduction: Although behavioral therapies can effectively treat skin picking disorder (SPD), there is no standardized treatment for improving SPD and its comorbidities and there is no group intervention option. This trial aimed to adapt the Rothbaum trichotillomania protocol to SPD (Study 1) and test its efficacy for treating SPD and comorbidities in individual and group formats (Study 2). Methods: The adapted protocol was applied to 16 SPD patients, who were allocated to group or individual treatment (Study 1). Afterwards, 54 patients were randomly allocated to treatment in an individual (n=27) or group format (n=27) (Study 2). In both studies, assessments of SPD severity, anxiety, depression, clinical status and skin lesion severity were performed at baseline and the endpoint. Results: The adapted protocol was feasible in both treatment modalities (Study 1) and led to high SPD remission rates (individual 63%; group 52%), with no significant difference between intervention types (p = 0.4) (Study 2). SPD, anxiety, and depression symptoms and objective patient lesion measures improved after treatment. There was large effect size for SPD symptom improvement in both treatment types (Cohen's d: group = 0.88; individual = 1.15) (Study 2). Conclusion: The adapted Rothbaum protocol was effective for SPD remission, comorbidities, and skin lesions, both in individual and group formats. Clinical trial registration: NCT03182478

Trichotillomania is more related to Tourette disorder than to obsessive-compulsive disorder

Objective: Trichotillomania (TTM) is characterized by the pulling out of one's hair. TTM was classified as an impulse control disorder in DSM-IV, but is now classified in the obsessive-compulsive related disorders section of DSM-5. Classification for TTM remains an open question, especially considering its impact on treatment of the disorder. In this review, we questioned the relation of TTM to tic disorder and obsessive-compulsive disorder (OCD). Method: We reviewed relevant MEDLINE-indexed articles on clinical, neuropsychological, neurobiological, and therapeutic aspects of trichotillomania, OCD, and tic disorders. Results: Our review found a closer relationship between TTM and tic disorder from neurobiological (especially imaging) and therapeutic standpoints. Conclusion: We sought to challenge the DSM-5 classification of TTM and to compare TTM with both OCD and tic disorder. Some discrepancies between TTM and tic disorders notwithstanding, several arguments are in favor of a closer relationship between these two disorders than between TTM and OCD, especially when considering implications for therapy. This consideration is essential for patients.

Tricotilomanía de nueva aparición durante el tratamiento con fármacos estimulantes. A propósito de dos casos clínicos pediátricos / New-onset trichotillomania during treatment with stimulant drugs. About two pediatric clinical cases

Los fármacos estimulantes se usan, habitualmente, en la población pediátrica para tratar el trastorno por déficit de atención e hiperactividad, y sus efectos secundarios están bien descritos. Sin embargo, la tricotilomanía no aparece como uno de ellos. En la literatura, hay algunos casos publicados de tricotilomanía en relación con la administración de metilfenidato y dextroanfetamina. Se presentan dos casos de tricotilomanía de nueva aparición en niños en seguimiento en nuestro Centro por déficit de atención e hiperactividad y en tratamiento con fármacos psicoestimulantes (metilfenidato y lisdexanfetamina), como probable efecto adverso de estos.

Stimulant drugs are commonly used in pediatric population in the treatment of attention deficit hyperactivity disorder, and their side effects are well described, however trichotillomania does not appear as one of them. In the literature we found some published cases of trichotillomania in relation to methylphenidate and dextroamphetamine. We present two cases of new-onset trichotillomania in children followed up in our center by attention deficit hyperactivity disorder and treated with psychostimulant drugs (methylphenidate and lisdexamfetamine), as a probable adverse effect of this treatment

Tricobezoar gastroduodenal en la edad escolar: Caso clínico / Gastroduodenal Trichobezoar in school age: Case report

Los bezoares son acumulaciones de sustancias orgánicas en el tracto gastrointestinal. El tricobezoar hace referencia a la acumulación de cabello, por lo general, en el estómago e incluso más allá de este (síndrome de Rapunzel). La incidencia de esta enfermedad es extremadamente rara; el 90 % de los casos se presentan en las mujeres, y el 80 % de estos ocurren en menores de 30 años y se encuentran relacionados con conductas de ansiedad y trastornos psiquiátricos. El abordaje integral en estos pacientes es fundamental, junto con el seguimiento interdisciplinario, para tratar las causas psicoemocionales subyacentes y realizar una adecuada psicoeducación con los pacientes y sus familiares, para disminuir el riesgo de posibles recidivas. Se presenta el caso clínico de una paciente en edad escolar, con antecedente de maltrato físico por parte de su padrastro y posteriores conductas ansiosas (tricotilomanía y tricofagia).

Bezoar is an accumulation of organic substances in the gastrointestinal tract; trichobezoar refers to the accumulation of hair usually in the stomach and even beyond it (Rapunzel syndrome). The incidence of this condition is extremely rare, 90 % of cases occur in women, and 80 % of these occur in those under 30 years of age and are related to anxiety behaviors and psychiatric disorders. The integral approach in these patients is fundamental, together with the interdisciplinary follow-up, treating the underlying psycho-emotional causes and adequate psychoeducation with the patients and their relatives, in order to reduce the risk of possible recurrences. We present the clinical case of a patient of school age, with a history of physical abuse by her stepfather and subsequent anxious behaviors (trichotillomania and trichophagia).

The cause of abdominal mass in a child with celiac disease: Rapunzel syndrome. A case report

ABSTRACT CONTEXT: Rapunzel syndrome is a rare form of gastric trichobezoar that develops through outstretching of the bezoar from the stomach to the intestine. CASE REPORT: A 12-year-old girl who had been diagnosed with celiac disease six years earlier was brought to the department of pediatric gastroenterology because of abdominal distension. A palpable mass was detected. A trichobezoar that stretched to the small intestine was removed surgically. The patient was diagnosed as having anxiety and depressive disorder, and treatment started. Following the treatment, her previous trichophagia completely disappeared. CONCLUSION: Presence of trichobezoar should be kept in mind, especially when young girls who have psychiatric problems suffer from gastrointestinal symptoms.

Tricobezoar de estómago / Gastric Trichobezoar Rapunzel Syndrome

Trichobezoars are an unusual pathology that appears generally in young adolescents associated with psychiatric disorders. The clinical presentation is very varied. The diagnosis is suspected by the clinical records of teen agers with trichophagia and trichotillomania and the digestive disorders are confirmed by the results of the endoscopy, the same as with images toward the therapeutic management. Undowbtly the treatment is surgical, and continuation with the psychiatric treatment is essential to avoid a recidival of the disease. Bezoar is a concretion formed in the alimentary tract, and according to the substances forming the ball, we find trichobezoar (foodball). The Rapunzel syndrome is an unusual complication of individual bezoar. When the trichobezoar located in the stomach extends through the pylorus into the small intestine and the right colon, is known as Rapunzel syndrome, that is an extremely rare gastric condition in humans. It is a rare form of trichobezoar, occurring in psychiatric patients with the trichobezoar (hairball) located in the stomach. The syndrome is named after the long haired girl Rapunzel in the fairy tale of the brothers Grimm. Most bezoars in teen agers are trichobezoars from swallowed hair. A 28-year-old patient is presented, with abdominal pain and vomiting, on the general physical examination the patient revealed a severe weight loss. Later on, through a gastrostomy, appeared the trichobezoar, being removed with good postsurgical resullts

A rare presentation of Rapunzel syndrome with multiple small bowel intussusceptions

Rapunzel syndrome is caused by gastric trichobezoar with extended tail and small bowel obstruction. Patients with gastric trichobezoar can be asymptomatic until the bezoar increases in size. We report a case of a girl who visited the emergency department with abdominal pain. She was finally diagnosed with Rapunzel syndrome that causes multiple small bowel intussusceptions associated with trichophagia. Surgery was needed to reduce the multiple intussusceptions, and to remove the large trichobezoar. This case highlights to consider the possibility of Rapunzel syndrome when diagnosing the main cause of intussusceptions.

Síndrome de Rapunzel con doble tricobezoar simultáneo en una adolescente: Reporte de caso / Rapunzel syndrome with double simultaneous trichobezoar in a teenager: Clinical Case Report

Resumen: Introducción: Los tricobezoares son acúmulos intraluminales de cabello ingerido. El síndrome de Rapunzel hace referencia a la presencia de los tricobezoares gástricos que se extienden al intestino delgado, sumados a la tricotilomanía y tricofagia, los cuales ocurren preferentemente en pacientes psiquiátricos en edad pediátrica. Objetivo: Analizar la aparición y manejo de este síndrome, propor cionando de igual manera datos acerca del entorno familiar y psicoemocional para que, por medio del análisis de los mismos, en un futuro se pueda identificar el riesgo en pacientes con circunstancias similares. Caso clínico: Paciente femenina de 14 años con antecedentes de tricotilomanía y tricofagia de dos años de evolución, que consultó por cuadro de dolor epigástrico asociado a sensación de plenitud posprandial, náuseas y pérdida de peso. Al examen destacaban áreas alopécicas en el cuero cabelludo y a la palpación abdominal se identificó un plastrón cuyo contorno parecía corresponder a los límites gástricos. En los estudios de imágenes se encontró una ocupación gástrica por bezoar. Con la laparotomía más gastrostomía se identificaron dos tricobezoares simultáneos en estómago y duodeno, que fueron resueltos quirúrgicamente y la paciente fue manejada con abordaje psicoemocional. Conclusión: El síndrome de Rapunzel, lejos de ser meramente una entidad quirúrgica, requiere un apoyo psicoemocional para prevenir su recurrencia y limitar su severidad.

Resumen: Introduction: Trichobezoars are an intraluminal accumulation of ingested hair. The Rapunzel syndrome refers to the presence of gastric trichobezoars which extend to the small intestine together with trichotillomania and trichophagia, that occur predominantly in psychiatric patients of pediatric age. Objective: To analyze the clinical course and resolution of this syndrome in a case report. Likewise, we provide information about the family environment and psycho-emotional context of the patients and help the reader identify similar circumstances in their clinical practice. Case report: Female 14-year-old patient with history of trichotillomania and trichophagia of two years of evolution, who consulted for epigastric pain associated with weight loss, nausea, and postprandial fullness. During the physical examination, the patient was found to have bald patches in the scalp along with a palpable mass that seemed to be confined to the gastric limits. Imaging studies revealed gastric occupation due to a bezoar formation. The patient was treated surgically with laparotomy and gastrostomy, and two simultaneous trichobezoars were removed from the patient´s stomach and duodenum, the patient also underwent psycho-emotional professional counseling. Conclusion: Rapunzel´s syndrome, far for being a merely surgical entity, also requires psychoemotional assessment to prevent it recurrence and limit its severity.

A Pilot Examination of Oxidative Stress in Trichotillomania

OBJECTIVE: Trichotillomania is a relatively common illness whose neurobiology is poorly understood. One treatment for adult trichotillomania, n-acetyl cysteine (NAC), has antioxidative properties, as well as effects on central glutamatergic transmission. Preclinical models suggest that excessive oxidative stress may be involved in its pathophysiology. METHODS: Adults with trichotillomania provided a blood sample for analysis of compounds that may be influenced by oxidative stress [glutathione, angiotensin II, ferritin, iron, glucose, insulin and insulin growth factor 1 (IGF1), and hepcidin]. Participants were examined on symptom severity, disability, and impulsivity. The number of participants with out-of-reference range oxidative stress measures were compared against the null distribution. Correlations between oxidative stress markers and clinical measures were examined. RESULTS: Of 14 participants (mean age 31.2 years; 92.9% female), 35.7% (n=5) had total glutathione levels below the reference range (p= 0.041). Other oxidative stress measures did not have significant proportions outside the reference ranges. Lower levels of glutathione correlated significantly with higher motor impulsiveness (Barratt Impulsiveness Scale sub-score) (r=0.97, p=0.001). CONCLUSION: A third of patients with trichotillomania had low levels of glutathione, and lower levels of glutathione correlated significantly with higher motor impulsiveness. Because NAC is a precursor for cysteine, and cysteine is a rate limiting step for glutathione production, these results may shed light on the mechanisms through which NAC can have beneficial effects for impulsive symptoms. Confirmation of these results requires a suitable larger follow-up study, including an internal normative control group.

Trichotillomania: a good response to treatment with N-acetylcysteine

Abstract: Trichotillomania is considered a behavioral disorder and is characterized by the recurring habit of pulling one's hair, resulting in secondary alopecia. It affects 1% of the adult population, and 2 to 4.4% of psychiatric patients meet the diagnostic criteria. It can occur at any age and is more prevalent in adolescents and females. Its occurrence in childhood is not uncommon and tends to have a more favorable clinical course. The scalp, eyebrows and eyelashes are the most commonly affected sites. Glutamate modulating agents, such as N-acetylcysteine, have been shown to be a promising treatment. N-acetylcysteine acts by reducing oxidative stress and normalizing glutaminergic transmission. In this paper, we report a case of trichotillomania with an excellent response to N-acetylcysteine.

Trichotillomania: a case report with clinical and dermatoscopic differential diagnosis with alopecia areata

ABSTRACT Trichotillomania is a psychodermatologic disorder characterized by uncontrollable urge to pull one's own hair. Differential diagnoses include the most common forms of alopecia such as alopecia areata. It is usually associated with depression and obsessive-compulsive disorder. Trichotillomania treatment standardization is a gap in the medical literature. Recent studies demonstrated the efficacy of N-acetylcysteine (a glutamate modulator) for the treatment of the disease. We report the clinical case of a 12-year-old female patient who received the initial diagnosis of alopecia areata, but presented with clinical and dermoscopic features of trichotillomania. She was treated with the combination of psychotropic drugs and N-acetylcysteine with good clinical response. Due to the chronic and recurring nature of trichotillomania, more studies need to be conducted for the establishment of a formal treatment algorithm.

Tricotilomania na análise de uma criança / Trichotillomania in the psychoanalysis of a child / Tricotilomanía en el análisis de un niña / Trichotillomanie dans l'analyse d'un enfant

A autora, mobilizada pelo processo analítico vivido com Laura, uma criança que praticava tricotilomania desde tenra idade, apresenta algumas vinhetas clínicas. O diálogo analítico possibilita, gradativamente, a criação e restauração da subjetividade por meio da representação simbólica do que estava inominado. Contribuições de autores psicanalíticos iluminam as conjecturas sobre a experiência emocional vivida pela dupla analista-analisando, ressaltando a importância fundamental, para o trabalho do analista no aqui e agora da sessão, do contato com o seu mundo interno e o do paciente, contato em que se conjugam o sentir e o pensar

The author presents some clinical vignettes after being touched by the psychoanalytic experience with a patient: a child with trichotillomania from early age. The dialogue gradually enables subjectivity to be created and restored by using the symbolic representation of what was innominate. Contributions from psychoanalytic authors enlighten the conjectures about the emotions the psychoanalytic pair - analyst and analysand - have experienced. The author emphasizes that it is vital for the psychoanalyst's work in the session his contact with both his patient's and his own inner world. In this contact, feeling and thinking are combined

La autora, movilizada por el proceso analítico vivido por Laura, una niña que practicaba tricotilomanía desde su tierna infancia, presenta algunas viñetas clínicas. El diálogo analítico posibilita, gradualmente, la creación y restauración de la subjetividad por medio de la representación simbólica de lo que estaba innominado. Contribuciones de autores psicoanalíticos iluminan las conjeturas sobre la experiencia emocional vivida por el par analista-analizada, resaltando la importancia fundamental, para el trabajo del analista en el aquí y ahora de la sesión, del contacto con su propio mundo interno y con el del paciente, contacto en el que se conjugan el sentir y el pensar

Mobilisée par le processus analytique vécu avec Laura, un enfant qui manifestait la trichotillomanie depuis le premier âge, l'auteur nous présente quelques vignettes cliniques. Le dialogue analytique permet, peu à peu, la création et la restauration de la subjectivité, au moyen de la représentation symbolique de ce qui n'était pas nommé. Des contributions d'auteurs psychanalytiques illuminent les conjectures sur l'expérience émotionnelle vécue par le double, analyste/analysant, en soulignant l'importance fondamentale pour le travail de l'analyste dans l'ici et le maintenant de la séance, du contact avec son monde intérieur et celui du patient, contact où l'on conjugue le ressentir et le penser

Tricobezoar. reporte de caso / Tricobezoar - case report / Trichobezoar - estudo do caso

El Tricobezoar es la acumulación de pelo en el tracto gastrointestinal generalmente asociado a trastornos psiquiátricos que conlleva a sintomatología obstructiva, deficiencias metabólicas y puede llevar a perforación intestinal, pancreatitis, intususcepción y colangitis. Caso: Paciente femenina de 11 años con cuadro clínico de 1 semana de evolución de dolor abdominal en epigastrio asociado a ausencia de deposiciones y antecedente de cuadro similar hace 2 semanas que resolvió con enema oral, se documentó Tricobezoar de 13 x 5 cm que generaba gran distensión en asas intestinales que fue removido por laparotomía con éxito. Conclusiones: Es una patología poco común asociada a un trastorno psicológico, que debe ser manejada quirúrgicamente en pro de prevenir complicaciones e incluye un tratamiento conjunto con psiquiatría y psicología para evitar recurrencias.

The Trichobezoar is the accumulation of hair on the gastrointestinal tract associated with psychiatric disorders generally leading to obstructive symptoms, metabolic deficiencies and, in some cases, intestinal perforation, pancreatitis, cholangitis or intussusception. Case: 11 years old female patient with clinical symptoms of 1 week duration of epigastric abdominal pain associated with bowel movements, patient referred history of similar symptoms two weeks ago that resolved with oral enema, tomography revealed a Trichobezoar 13 x 5 cm generating large strained bowel loops which was successfully removed by laparotomy. Conclusions: Trichobezoar is a rare entity associated with a psychological disorder that needs to be handled surgically towards preventing complications and includes a set psychiatric and psychological treatment to prevent recurrences

Trichobezoar é o acúmulo de pêlos no trato gastrointestinal associado com transtornos psiquiátricos geralmente levando a sintomas obstrutivos, deficiências metabólicas e, em alguns casos, perfuração intestinal, pancreatite, colangite ou intussuscepção. Caso: Paciente do sexo feminino com 11 anos de idade com sintomas clínicos de 1 semana de duração da dor abdominal epigástrica associada a movimentos intestinais, paciente relatou história de sintomas semelhantes há duas semanas que resolveram com enema oral, a tomografia revelou um tricobezoar de 13 x 5 cm, foi removido com sucesso por laparotomia. Conclusões: Trichobezoar é uma entidade rara associada a um transtorno psicológico que precisa ser tratado cirurgicamente para prevenir complicações e inclui um conjunto de tratamento psiquiátrico e psicológico para prevenir recorrências