Tricobezoar gástrico gigante: reporte de un caso clínico-patológico

Un tricobezoar es una masa compacta de pelo que se aloja generalmente en el estómago. Es frecuente en mujeres jóvenes que comen su propio pelo (tricofagia) debido a trastornos psicológicos. Presentamos el caso de una adolescente de 13 años de edad quien es traída por emergencia por presentar dolor abdominal persistente desde hace 3 días. La ecografía abdominal fue sugestiva de tricobezoar, hallazgo que fue confirmado mediante una endoscopia digestiva alta. Desde hace dos años antes de su ingreso, presentaba, masticación de cabello y consumo del mismo que asocia a viaje de su hermano al extranjero y a la separación de sus padres. Al noveno día, se realizó laparotomía exploratoria con gastrostomía extrayendo tricobezoar gástrico, que en el estudio anatomopatológico pesó 1033,8 g y midió 31,5 x 18 cm. en sus dimensiones mayores. Estos casos son sumamente raros. En nuestro caso el tricobezoar alcanzó el tamaño más grande de los hasta ahora reportados. Contradictoriamente la sintomatología fue mínima.

A trichobezoar is a compact mass of hair that is usually stored in the stomach. It is common in young women who eat their own hair (trichophagia) due to psychological disorders. We present the case of a 13-year-old teenager who had been brought in an emergency for having persistent abdominal pain for 3 days. Abdominal ultrasound was suggestive of trichobezoar, a finding that was confirmed by upper gastrointestinal endoscopy. For two years before her admission, she had chewed her hair and consumed it, which she associated with her brother's trip abroad and the separation of her parents. On the ninth day, an exploratory laparotomy with gastrostomy was performed, extracting gastric trichobezoar, which in the anatomopathological study weighed 1033.8 g. and measured 31.5 x 18 cm. in its larger dimensions. These cases are extremely rare. In our case, the trichobezoar reached the largest size of those reported so far. Contradictorily, the symptoms were minimal.

Tricobezoar gástrico: reporte de un caso y revisión de la literatura

El bezoar gástrico es una tumoración por cuerpo extraño que resulta de la acumulación de material no digerible en el estómago. El tricobezoar es uno de ellos y frecuentemente se presenta en la población femenina joven que padece trastornos psiquiátricos. La presentación del bezoar gástrico es insidiosa e inespecífica, teniendo un curso inicialmente asintomático por años, hasta que alcanza un tamaño que evidencia síntomas. El método diagnóstico de elección es la endoscopía, ya que permite visualizar el bezoar y plantear el tratamiento. El abordaje terapéutico estará determinado por el tipo, tamaño y consistencia de este; sin embargo, la resolución quirúrgica es la de elección, la cual siempre debe estar asociada a tratamiento psiquiátrico para prevenir la recurrencia del cuadro. Se presenta el caso de una paciente de 19 años con el diagnóstico de tricobezoar gástrico, asociado a tricotilomanía y tricofagia como patologías de fondo, y se realiza una revisión de la literatura.

A gastric bezoar is a foreign body tumor that results from the accumulation of indigestible material in the stomach. The trichobezoar is one of them and frequently occurs in the young female population suffering from psychiatric disorders. The presentation of the gastric bezoar is insidious and nonspecific, having an initially asymptomatic course for years, until it reaches a size that shows symptoms. The diagnostic method of choice is endoscopy since it allows the bezoar to be visualized and propose the treatment. The therapeutic approach will be determined by its type, size, and consistency; however, surgical resolution is the one of choice, which must always be associated with psychiatric treatment to prevent recurrence of the condition. The case of a 19-year-old patient with a diagnosis of gastric trichobezoar, associated with trichotillomania and trichophagia as underlying pathologies is presented, and a literature review is carried out.

Sugarcane fibre may prevents hairball formation in cats.

Hair ingested by licking during cat grooming can eventually coalesce into solid masses in cat gastrointestinal tract. It is believed that dietary fibre might reduce formation of these trichobezoars (hairballs). The effects of two insoluble fibre sources added to kibble diets were evaluated with respect to trichobezoar faecal excretion. Thirty-two cats and four diets were used in a randomised block design: a control diet without additional fibre, 10 % added sugarcane fibre, 20 % added sugarcane fibre or 10 % added cellulose. Animals were fed for 42 d and during three separate periods (days 15-17, 25-27 and 40-42), the cats were housed individually in metabolic cages and their faeces were totally collected. The faeces were evaluated and the trichobezoars were isolated and classified into small (<1 cm), medium (1·1-2 cm) or large (>2·1 cm). Means were evaluated by repeated measures ANOVA and contrasts (P < 0·05). Cats fed sugarcane fibre shown a linear reduction of small and medium trichobezoar excretion (number per cat per day; P = 0·004) as well as a reduction in trichobezoar mass excretion (mg per cat per day; P < 0·01). The control group showed increased faecal excretion of large trichobezoars (P = 0·003), which were not present in the high sugarcane fibre group (P < 0·006). No effect of cellulose was observed for any evaluated trait. Therefore, long fibres (sugarcane fibre) may cause greater peristaltic stimulation, increasing the propulsion of hair through the gut, but further research is needed to validate this mechanism. In conclusion, sugarcane fibre reduced faecal hairball elimination in cats, which may have clinical applications for the prevention of health problems related to trichobezoars.

Síndrome de Rapunzel: revisão de literatura / Rapunzel syndrome: a literature review

Tricobezoar gastroduodenal é definido como o acúmulo de cabelos e pelos no trato gastrointestinal, tendo como origem a ingestão dessas substâncias. As autoras relatam o caso de um volumoso tricobezoar associado à síndrome de Rapunzel, em jovem do sexo feminino com história de tricotilofagia e emagrecimento. Foram utilizados, como base de dados, a revisão de prontuário, a avaliação dos exames realizados e o acompanhamento durante o ato operatório. Apesar de ser um caso incomum, é necessário aventar sua hipótese diagnóstica diante de uma clínica exuberante como a da referida paciente. Não somente o bezoar deve ser adequadamente tratado, mas também a causa subjacente que levou a paciente à ingestão de cabelos.

Gastroduodenal trichobezoar is the accumulation of hair inside the gastroduodenal tract, originated by the ingestion of such object. On the presented study is reported the case of a voluminous trichobezoar associated with Rapunzel's syndrome on a young female with history of trichophagia and weight loss. With this purpose, chart review, assessment of the tests, and monitoring during the surgery were used. Despite being an unusual case, it should be suspected in a clinical exuberant as the patient, and must be properly treated, not only the bezoar itself, but the underlying cause that led to the ingestion of hair.