An Unusual Cause of T Tube Obstruction: ‘Tricho-Tracheobezoar’

Suttithawil, Wudthichai; Karnak, Demet; Machuzak, Michael; Gildea, Thomas R.; Mehta, Atul C.

doi:10.1159/000099616

Cited by 7 publications

(10 citation statements)

References 19 publications

(10 reference statements)

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“…Complications of trichobezoar formation, and of bezoars, more generally, include malabsorption, malnutrition, anemia, cachexia, hypoalbuminemia, and intussusception 26 . Fatal cases of trichobezoar are rare and are typically secondary to mechanical obstruction of the gastrointestinal tract (perforation, peritonitis, sepsis, and multiorgan failure) 16,26–29 or airways 30 …”

Section: Discussionmentioning

confidence: 99%

“…26 Fatal cases of trichobezoar are rare and are typically secondary to mechanical obstruction of the gastrointestinal tract (perforation, peritonitis, sepsis, and multiorgan failure) 16,[26][27][28][29] or airways. 30 Radiological investigations are the primary diagnostic modalities for the antemortem identification of trichobezoar and Rapunzel syndrome. In reported cases in which patients received preoperative imaging, upper gastrointestinal endoscopy has been considered the radiological investigation that provides a definitive diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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Fatal Rapunzel Syndrome

Żyła

Jacques

2023

Am J Forensic Med Pathol

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We report a rare case of a young child, younger than10 years, who died of complications related to trichophagia and multiple gastrointestinal trichobezoars. One year before death, the child's clinical history yielded a diagnosis of iron deficiency anemia, believed to be related to poor diet, and alopecia areata, the etiology of which was unknown. Two weeks before death, the child presented with complaints of intermittent “flu-like” symptoms and vomiting. The child reported abdominal pain, anorexia, and fatigue on the night before death. The next morning, the child ate breakfast and was subsequently discovered unresponsive. On external examination, there were areas of thinning head hair. Postmortem computed tomography, magnetic resonance imaging, and internal examination revealed 3 distinct trichobezoars, occupying the stomach, jejunum, and ileum. This was complicated by small bowel obstructions and perforations due to the trichobezoars. The cause of death was peritonitis secondary to small bowel perforations due to small bowel obstruction with multiple trichobezoars. This is the first case report to demonstrate the utility of postmortem computed tomography and magnetic resonance imaging in characterizing the nature and extent of trichobezoars in a fatal case of Rapunzel syndrome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Fatal Rapunzel Syndrome

Żyła

Jacques

2023

Am J Forensic Med Pathol

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“…Clinically, trichobezoar patients present gastrointestinal disorders as the main complications [6]. Literature review showed that trichobezoars were seen in some rare cases, including (a) a 5-year-old female with trichotillomania and trichophagia with increased airway resistance as a primary component of laryngeal collapse [6], (b) a 51-yearold female with unusual dyspnea and T-tube obstruction [7], and (c) some cases in cats with an acute onset of dyspnea without or with prior clinical signs of esophageal disease and esophageal trichobezoars [8]. Esophageal foreign bodies with pure acute dyspnea have been also reported in the literature [9].…”

Section: Discussionmentioning

confidence: 99%

Uncommon cause of respiratory failure due to a bezoar in the hypopharynx: a case report

et al. 2022

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Background Trichotillomania and trichophagia cause trichobezoars, which are masses made of hair. The main presentation of this condition is abdominal pain. However, other complications include gastric outlet obstruction, nausea, vomiting, weight loss, malnutrition, hematemesis, diarrhea, and constipation. Case presentation A 57-year-old woman with trichotillomania was admitted to the Emergency Department with the chief complaints of dyspnea on exertion, shortness of breath, dysphagia, generalized weakness, and hoarseness. Spiral chest computed tomography (CT) scan did not reveal any parenchymal lesions Pulmonary CT angiography did not reveal pulmonary embolism. The patient was admitted to the Surgery Department for hand fasciotomy due to contrast leakage, and during laryngoscopy, a trichobezoar was detected that was removed with Magill forceps. Conclusions Rare cases of trichobezoars can be observed in humans with gastrointestinal and respiratory symptoms. Precise and timely diagnosis are key for the prevention of more invasive diagnostic procedures.

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“…Upper airway obstruction is not restricted to pharmacobezoars, as it may also be secondary to trichobezoar formation. This occurred in a case with obstruction of a T‐tube device used to maintain tracheal patency in the setting of tracheal stenosis by a thick mass of mucus and hair .…”

Section: Discussionmentioning

confidence: 99%

Forensic Features of Pharmacobezoars

England

Heath

Gilbert

et al. 2014

Journal of Forensic Sciences

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Three cases of pharmacobezoars are reported to demonstrate typical autopsy findings and potential lethal mechanisms: (i) A 32-year-old woman died following an overdose of prescription medications. A gelatinous pharmacobezoar was found forming a cast of her bronchial tree. (ii) A 24-year-old woman also died following an overdose of prescription medications. At autopsy, two pharmacobezoars were present, one within the larynx and another occluding the right main bronchus. Deaths in both cases were attributed to airway occlusion by pharmacobezoars complicating mixed drug toxicity. (iii) A 79-year-old man was found dead in a car. Death was attributed to the combined effects of carbon monoxide and drug toxicity with a large pharmacobezoar lodged within the esophagus. Pharmacobezoars are specific types of bezoars that occur when pharmaceutical materials, such as tablets, suspensions, and/or drug delivery devices, aggregate and contribute to death by occluding airways with tenacious material or by eluting drugs.

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An Unusual Cause of T Tube Obstruction: ‘Tricho-Tracheobezoar’

Cited by 7 publications

References 19 publications

Fatal Rapunzel Syndrome

Fatal Rapunzel Syndrome

Uncommon cause of respiratory failure due to a bezoar in the hypopharynx: a case report

Forensic Features of Pharmacobezoars

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