Approach to Trichobezoar Cases in Children: Literature Review

Abstract

Trichobezoar is a mass found trapped in the gastrointestinal system formed from the ingestion of hair. They are mostly localized inside the stomach, and they can occasionally extend from the pylorus into the duodenum and small intestines. At the same time, they are almost always associated with trichotillomania, trichophagia, and other psychiatric diseases. Trichobezoar can be easily confused with other diseases characterized by abdominal pain and vomiting. Removal of the mass with laparotomic, laparoscopic, and endoscopic interventions is an available treatment approach. Among them, the laparotomic approach is the most effective treatment modality. Herein, we present a case and reviewed the literature from a general outlook in order to emphasize current, updated approaches to the pediatric cases with trichobezoar. GirişTrikobezoar, çoğunlukla proksimal gastrointestinal sistemi etkileyen, bulgu ve belirtileri nedeniyle diğer karın ağrısı ve kusmaya yol açan patolojilerle kolayca karışabilen nadir bir tablodur. İnsan saçı, yüzeyinin pürüzsüz olması ve keratinöz yapısı nedeniyle sindirime dirençlidir. Midenin mukoza katlantıları arasında kolayca birikir; zaman geçtikçe yiyecek parçaları ve mukus ile kitlesel bir hal alır, böylece trikobezoar oluşur (1-4). Trikobezoarlar bazen pilordan duodenuma, jejenuma hatta kolona kadar ilerler. Vaughan ve ark. (5-8) bu duruma Rapunzel sendromu adını vermişlerdir. Bu sendromda trikobezoarın kuyruk kısmının kopmasına bağlı ince barsakta tıkanıklıklar oluşabilir (3, 9). Bazen de oddi sfinkterine direkt etki ederek aralıklı safra yolu obstrüksiyonu nedeni olabilir (10). Erken dönemde trikobezoarı spesifik olmayan semptomları dolayısı ile tanımak zordur. Bu yüzden psikiyatrik rahatsızlığı olan genç kızlarda, saçını koparma ve yutma davranışları varsa trikobezoardan şüphelenilmelidir. Ayrıca trikobezoarın mental retardasyon, yabancı madde kullanımı, pika, depresyon gibi durumlara eşlik edebileceği unutulmamalıdır (3). Trikobezoarların tanısı, spesifik olmayan semptomları olması ve ayrıcı tanıda kolay akla getirilmemesi nedeniyle genellikle gecikir. Büyüyen kitle mide ve barsakta mukozal ülserasyona hatta perforasyona neden olabilir. Literatürde tanısı geciken trikobezoara bağlı protein enerji malnütrisyonu, tıkanma sarılığı, pankreatit hatta ölüm bile bildirilmiştir (3,(11)(12)(13)(14). Laparoskopik ve endoskopik yöntemlerin gelişmesi sonrası trikobezoar tedavisinde laparotominin yeri sorgulansa da halen altın standart olma özelliğini korumaktadır (3,

Rapunzel Sendromuna Bağlı İntestinal Obstrüksiyonun Farklı Bir Klinik Sunumu: İshal

“…Fatigue, weight loss, iron deficiency, megaloblastic anemia, hematemesis, protein losing enteropathy, constipation and diarrhea, gastric mucosal erosion, ulceration are some chronic complication of untreated trichobezoars. 1,2,[4][5][6][7] Some acute complications of trichobezoars are intestinal and gastric outlet obstruction, perforation, intussuception. 1,5 In our case, there was bilious vomiting that started with diarrhea.…”

“…1,2,[4][5][6][7] Some acute complications of trichobezoars are intestinal and gastric outlet obstruction, perforation, intussuception. 1,5 In our case, there was bilious vomiting that started with diarrhea. Although the diarrhea stopped in 12-24 hours, bilious vomiting continued, and the patient was consulted to us.…”

“…1 Trichobezoars are associate with some disorders such as obsessive-compulsive disorders, anxiety, depression, mental disorders, abuse, pica and anorexia nevrosa. [3][4][5] Although trichobezoar is mostly formed by the person swallowing her own hair (trichophagia), also rarely formed by the ingestion of other family members hair or structures such as doll or pet. 5 There will be no clinical complaints due to hair that starts to accumulate in the stomach during early stages.…”

“…[3][4][5] Although trichobezoar is mostly formed by the person swallowing her own hair (trichophagia), also rarely formed by the ingestion of other family members hair or structures such as doll or pet. 5 There will be no clinical complaints due to hair that starts to accumulate in the stomach during early stages. Growing hair ball can lead to silent symptoms like fatigue, weight loss, nausea, vomiting, intermittent epigastric pain, constipation and diarrhea.…”

“…1,2 Hair ball, increasing in size and weight due to ongoing trichophagia habit, lead to complications like iron deficiency, megaloblastic anemia, hematemesis, protein losing enteropathy, gastric mucosal erosion, gastric outlet and intestinal obstruction, perforation, intussusception, pancreatitis, peritonitis and death. 1,2,5,6 We aimed to present a case whose first application complaints are diarrhea and vomiting due to trichobezoar obstruction in small bowel.…”