Endoscopic shaving of hair in a gastric bypass patient with a large bezoar

Abstract

Trichotillomania can be associated with the formation of trichobezoars (hair ball) usually located in the stomach. Trichobezoars may lead to complications including bowel obstruction, and perforation. Patients with a history of diabetes, certain psychiatric disorders, prior gastric surgery and poor mastication ability are at an increased risk of developing bezoars. We are presenting a case of patient who suffered from a large, recurrent trichobezoar, who had a history of gastric bypass surgery as well as trichotillophagia. The endoscopic method used to remove the large bezoar will also be discussed. We have reviewed the cases published, in which patients developed bezoars after undergoing gastric bypass surgery. The purpose of this study is to raise awareness among clinicians that patients with certain psychiatric issues who had prior gastric surgeries, are at eminent risk of bezoar formation. A multidisciplinary approach including cognitive behavioural therapy, dietary education and pharmacotherapy should be taken to prevent complications.

Acute Presentation of Rapunzel Syndrome and a Review of Bezoars

“…The extension of trichobezoars into the cecum and ascending colon as shown in our patient's abdominal X-ray supports the diagnosis of Rapunzel Syndrome. Other complications include bowel obstruction, perforation, intussusception, malnutrition, haematemesis and obstructive jaundice [1][2][3]5].…”

“…Bezoar, derived from the Arabic word 'Bazahr', refers to an agglutination of indigestible content in the gastrointestinal tract [1][2][3]. Bezoars have different compositions and can be subdivided into trichobezoar (hair ball), phytobezoar (plant), pharmacobezoar (medicinal preparation), lactobezoar (milk curds) and food bolus [1,[4][5][6]. The reported incidence of bezoar is 0.4% with phytobezoar being the commonest [6].…”

“…Trichobezoar is usually secondary to trichotillomania and trichophagia with scalp, eyebrows and eyelashes being the commonest sites [ 3 , 5 ]. Atypical dietary habits, impaired mastication, diabetic gastroparesis, achlorhydria and gastric dysmotility secondary to gastrectomies may also contribute to the formation of trichobezoars [ 1 ].…”

Etiological aspects of intragastric bezoars and its associations to the gastric function implications

“…[ 19 ] Moreover, psychiatric therapy and dietary education are recommended. [ 2 ] Endoscopic examination for surveillance should be carried out if the disease recurs frequently.…”

“…Bezoars are collections or concretions of undigested material anywhere in the gastro-intestinal tract (GIT), and most commonly found in the stomach due to altered or normal gastric physiology, abnormal GI motility, weakened gastric emptying, and other coexisting illness. [ 1 , 2 ] Bezoars occur frequently in people with certain risk factors, or comorbid conditions. Bezoars are classified according to the material that forms them, such as, phytobezoars or diospyrobezoars; indigestible fruit or vegetable content, trichobezoars; hair, lactobezoars; milk products and pharmacobezoars; tablets and medications.…”