SummaryA 45-year-old Afro-Caribbean woman attended the emergency department with worsening dysphagia, abdominal distension, abdominal pain, shortness of breath and generalised weakness. She enjoyed preparing and eating cows-feet stew and preferred to cook the meat with the hair and skin intact. On admission she had a severe microcytic anaemia and was malnourished. Abdominal x-ray and CT revealed a large gastric bezoar. At gastrotomy a foul-smelling 2.42 kg mass of hair, leathery skin and altered food were evacuated from the lesser curvature of the stomach. She had undergone the same procedure 8 years earlier to remove a similar trichobezoar.Following psychiatric review it was deemed that the patient had no underlying psychiatric condition and had full insight into why her trichobezoar had re-occurred. She made a good postoperative recovery and stopped eating cows-feet stew.
BACKGROUND
Chronic myeloid leukaemia (CML) is a myeloproliferative neoplasm that accounts for 15% of newly diagnosed cases of leukaemia in adults [1]. In the developed world, 50% of patients are asymptomatic at diagnosis with the disease picked up on routine examination and blood testing. At presentation, 90%-95% of patients have chronic phase CML during which signs and symptoms typically result from anaemia and splenomegaly [2]. Ophthalmic presentations of CML are uncommon, F I G U R E 1 (A and B) Right and left wide-field fundus images showing bilateral Roth spots and peripheral perivascular sheathing. (C and D) Improvement at 4 weeks following treatment This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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