Gastric Trichobezoar: An Important Cause of Abdominal Pain Presenting to the Pediatric Emergency Department

Abstract

Abdominal pain is a common presenting complaint of children seen in urgent care settings. It is the manifestation of a wide variety of disease processes ranging from benign to immediately life-threatening. Gastric bezoars are among the etiologies of chronic childhood abdominal pain that, when undiagnosed, may result acutely in serious complications, including gastric ulceration, bleeding and perforation, intussusception, and small bowel obstruction. To reinforce the importance of including this entity in the differential diagnosis of abdominal pain, we present the case of a 10-year-old girl with a history of chronic epigastric complaints who was ultimately presented with acute small bowel obstruction following fragmentation and distal migration of her gastric trichobezoar. Finally, we review and briefly summarize the current literature regarding the etiology, diagnosis, and management of this disorder in children.

The Rapunzel syndrome. Report of a case

“…Up to 90% of the all trichobezoars occur in girls younger than 20 years old. Males are rarely affected (3).…”

A non-occlusive bezoar of caecum in a 7-year-old child: ultrasound detection and multimodality imaging management

“…Bezoars are gastro-intestinal foreign bodies which result from swallowed but incompletely digested foods or vary materials [12]. Bezoars rarely cause gastro-intestinal obstructions, which are the most frequent presentations especially for that located in the stomach and small bowel.…”

“…Ultrasound represents a new, noninvasive, easily performed, imaging technique without use of ionizing radiations. In literature [9,12] very few works are described about the useful role of Ultrasound in the diagnosis of colonic bezoar especially in children, because it can produce images similar to other pathological conditions [9]. Indeed the fecal material in the colon, at Ultrasound, can simulate the image of a bezoar but at CT it corresponds to gas bubbles in particulate matter, arranged in elongated form of greater length and a less compact nature than bezoars [9].…”

Trichobezoar with Gastric Perforation

“…[5] The clinical presentation of trichobezoar varies from non-specific symptoms like; anorexia, anemia, weight loss, gastrointestinal bleeding and recurrent abdominal pain to a more serious presentation as intestinal obstruction and perforation. [6][7][8] The most common complication is perforation of either the stomach or the intestine. In present case patient presented with features of peritonitis while Gonugunthla et al reported a 5 year old female with features of abdominal mass for which gastrotomy was performed and trichobezoar with a tapering tail extending into the small bowel was removed.…”