A huge abdominal mass revealing a depressive syndrome

Abstract

Trichobezoar is a rare condition that occurs mostly in young women with psychiatric disorders such as trichotillomania and trichophagia. We report the case of a giant gastric trichobezoar in a 21-year-old woman who presented with chronic abdominal pain, vomiting and weight loss. Abdominal examination revealed a large epigastric mass. Endoscopic and imaging findings were highly suggestive of a gastric trichobezoar. Surgical extraction of the huge hair mass was successfully performed through an open gastrotomy. Postoperatively, history of a neglected chronic depression with suicidal ideation was diagnosed. Consequently, the patient was referred to the psychiatric department for mental healthcare, to prevent trichobezoar recurrences.

Multidisciplinary treatment of massive trichobezoar caused an acute gastric outlet obstruction

“…After surgical removal of trichobezoars, clinical and EGDS follow-up is advised during next 6, 12 and 24 months due to potential abdominal complications or early detection of recurrence of trichophagia with asymptomatic trichobezoars in the stomach or intestines [19,20,21]. This case emphasizes the importance of trichobezoars as a differential diagnosis in early diagnostic and therapeutic procedures in young females with non-specific upper abdominal complaints and an epigastric palpable mass.…”

“…The therapeutic approach using EGDS is not suitable for all patients, as was the case with our patient because it was impossible to fragment the solid impacted gastric mass and there was a risk of unintentional stomach injury. Treatment removal of the foreign body, endoscopically or surgically, by laparoscopic or open surgical approach [17][18][19][20][21].…”

“…We performed open midline laparotomy with gastrotomy following by complete bezoar extraction, without any complications. Some studies reported only 5% of successful endoscopic bezoars removals, successful rate of 75% for laparoscopic extraction and 99% successful for conventional laparotomy with gastrotomy [17][18][19][20][21]. Therefore, laparotomy it is considered the treatment of choice.…”