Treatment of large gastric trichobezoar in children: Two case reports and literature review.

RATIONALE: Gastric trichobezoars are a rare form of bezoar formed from swallowed human hair as well as hair from dolls or animals, blankets, and carpets. They usually develop in young women who are emotionally disturbed, depressed, or mentally retarded, with trichotillomania and trichophagia. They can lead to abdominal pain, gastric ulceration, bleeding, obstruction, and perforation. PATIENT CONCERNS: A 13-year-old girl was admitted to our institution with complaints of nausea, vomiting, and epigastric pain for 2 days. She underwent laparoscopic removal of a large gastric trichobezoar at our institution 5 years ago. A 12-year-old girl presented at our institution due to epigastric pain, dizziness, and melena for 2 days. DIAGNOSIS: They were diagnosed with gastric trichobezoar by abdominal computed tomography scan and upper gastrointestinal endoscopy. INTERVENTIONS: Large gastric trichobezoars were removed via a mini-laparotomy. OUTCOMES: They recovered well postoperatively without complication. LESSONS: Although the recurrence of gastric trichobezoar after surgery is rare, few recurrent cases were reported in the literature. Therefore, psychiatric consultation and regular follow-up after treatment should be considered in the children and their parents to prevent the recurrence of gastric trichobezoar.

Trichotillomania, trichophagia, trichobezoar - summary of three cases. Endoscopic follow up scheme in trichotillomania.

AIM: Trichotillomania is a lack of control of one's hair pulling. It is estimated that about 1% of population develops trichotillomania. In up to 20% of patients with trichotillomania swollowing follows hair pulling. Trichobezoar forms in about 30% of patients with trichofagia. MATERIAL AND METHODS: In 2008-2014 3 patients were operated on trichobezoar. One patient has had a history of trichotillomania. On admission abdominal X-ray and ultrasonography revealed abdominal mass. Diagnosis was confirmed in abdominal computed tomography. RESULTS: All three trichobezoars were evacuated from the intestinal tract during laparotomy with wide gastric wall opening. In one case - Rapunzel syndrome - hair mass was evacuated also from the duodenum and small bowel. All patients were referred to psychiatrist after finishing of the surgical treatment. CONCLUSIONS: In patients operated for trichobezoar as well as other patients with trichotillomania control of hair accumulation in the gastrointestinal tract remains a problem. Authors propose endoscopic follow up scheme in 6, 12, and 24 months after the surgery as well as for other patients with trichotillomania.

Rapunzel syndrome in a Thai girl with an asymptomatic abdominal mass: a case report.

Rapunzel syndrome is an uncommon form of trichobezoar (a collection of ingested hair in the stomach that fails to pass through the intestine) with an extension of hair into the small bowel. The authors report in the present article a case of Rapunzel syndrome in a 10-year-old Thai girl with an asymptomatic abdominal mass incidentally detected during a hospital visit. She did not have nausea, vomiting, abdominal pain, weight loss, or any other symptoms. A movable, firm and smooth epigastric mass 10 x 12 cm in size was found upon examination. Eventually the trichobezoar mass was surgically removed after a failed endoscopic removal.

Trichotillomania, recurrent trichobezoar and Rapunzel syndrome: case report and literature review.

BACKGROUND: Bezoar is a conglomeration of foreign material in the intestinal tract. Trichobezoar (accumulation of hair in the gastric chamber, secondary to impulsive pulling and intake) and Rapunzel syndrome (accumulation of hair in the small intestine) usually occur in children and adolescents with trichotillomania (TTM) and trichophagia history. CLINICAL CASE: We present the case of a 22-year-old female who arrived for consultation. The patient had a 10-month history of intermittent abdominal pain, gastric fullness, nausea, occasional vomiting and weight loss. In addition, she had a history of TTM, trichophagia and previous gastrotomy at 16 years of age. Laboratory tests revealed hypochromic microcytic anemia. Ultrasonographic study demonstrated intense sonic shadowing posterior to the gastric area. After performing gastrotomy, the specimen was extracted and consisted of hair that occupied the entire length of the gastric chamber and part of the small intestine. CONCLUSIONS: TTM is characterized by recurrent and impulsive pulling of one's hair for pleasure, gratification, or relief of tension. Children and women <30 years of age are the groups who most frequently suffer from this type of disorder. Hair intake sensation was a cause for presentation of the disease. Data recollection in our environment may provide information for the determination of new information regarding the presence of this condition.

Tricotilomanía, tricobezoar de repetición y síndrome de Rapunzel: informe de un caso y revisión de la literatura / Trichotillomania, recurrent trichobezoar and Rapunzel syndrome: case report and literature review

Introducción: Un bezoar es un conglomerado de material extraño en el tracto intestinal. El tricobezoar (acumulación de cabello en la cámara gástrica) y el síndrome de Rapunzel (acumulación en el intestino delgado) suelen aparecer en niños y mujeres adolescentes con antecedente de tricotilomanía y tricofagia. Caso clínico: Mujer de 22 años de edad con dolor abdominal intermitente, plenitud gástrica, náuseas, vómito ocasional y pérdida ponderal de 10 meses de evolución. Antecedentes de tricotilomanía, tricofagia y gastrotomía a los 16 años. Los exámenes de laboratorio revelaron anemia microcítica hipocrómica y el ultrasonido mostró una sombra sónica posterior en la cámara gástrica. Por gastrotomía se extrajo un conglomerado de cabello que ocupaba el estómago y parte del intestino delgado. Conclusiones: La tricotilomanía y tricofagia son más comunes en las mujeres menores de 30 años. La sensación que experimentaba la paciente al deglutir los cabellos provocaba la ingesta. La recopilación de datos puede proporcionar información acerca de los determinantes que influyen en la aparición de la enfermedad.

BACKGROUND: Bezoar is a conglomeration of foreign material in the intestinal tract. Trichobezoar (accumulation of hair in the gastric chamber, secondary to impulsive pulling and intake) and Rapunzel syndrome (accumulation of hair in the small intestine) usually occur in children and adolescents with trichotillomania (TTM) and trichophagia history. CLINICAL CASE: We present the case of a 22-year-old female who arrived for consultation. The patient had a 10-month history of intermittent abdominal pain, gastric fullness, nausea, occasional vomiting and weight loss. In addition, she had a history of TTM, trichophagia and previous gastrotomy at 16 years of age. Laboratory tests revealed hypochromic microcytic anemia. Ultrasonographic study demonstrated intense sonic shadowing posterior to the gastric area. After performing gastrotomy, the specimen was extracted and consisted of hair that occupied the entire length of the gastric chamber and part of the small intestine. CONCLUSIONS: TTM is characterized by recurrent and impulsive pulling of one's hair for pleasure, gratification, or relief of tension. Children and women <30 years of age are the groups who most frequently suffer from this type of disorder. Hair intake sensation was a cause for presentation of the disease. Data recollection in our environment may provide information for the determination of new information regarding the presence of this condition.

Obstrução intestinal e tricobezoar: relato de um caso recidivante / Trichobezoar and intestinal obstruction: report of a recurrent case

Introdução: Tricofagia é o ato de mastigar e engolir cabelos. Tricobezoares são aglomerado de cabelo singeridos, afetando mais comumente o estômago e o duodeno, podendo causar obstruções, perfurações, ulcerações e sangramentos. Relato do Caso: A finalidade do presente trabalho é relatar o caso de uma paciente com história de cirurgia por tricobezoar há 16 anos, apresentando, no momento da admissão, quadro de obstrução intestinal de mesma etiologia, sendo necessário tratamento cirúrgico para retirada de um tricobezoar gástrico e outro intestinal, o qual causava obstrução a dez centímetros da válvula íleo-cecal. Discussão: O presente relato destaca-se pelo fato de que a paciente apresentou recorrência do tricobezoar e pela obstrução intestinal baixa concomitante. Conclusão: A recorrência do tricobezoar é rara, porém deve ser aventada como hipótese diagnóstica em pacientes que já apresentaram tal afecção e procuram atendimento médico com obstrução intestinal.

Trichophagy is the act of chewing and swallowing hair. Trichobezoars are glomerate of ingested hair, more commonly affecting the stomach and duodenum. They cause obstructions, perforations, ulcerations and bleedings. The purpose of this study is to report the case of a female patient with intestinal obstruction caused by trichobezoars, admitted at a school hospital who had already been submitted to a laparotomy 16 years ago for the same reason. The obstruction was resolved by removing the trichobezoar from the stomach and the ileum after gastrotomy and enterotomy. This case can be considered important since it reports the trichobezoar recurrence as well as the presence of intestinal obstruction . Trichobezoar recurrence is rare, however, this hypothesis must be considered in patients with previous history of this affection who looks for medical assistance in the presence of intestinal obstruction.