Gastric trichobezoar in an end-stage renal failure and mental health disorder presented with chronic epigastric pain: A case report

Abstract

Background Gastric trichobezoar happens when there is an indigestible substance or food found in the gastrointestinal tract. It is a rare presentation which is usually associated with trichotillomania and trichopagia. The presentation may not be specific and is usually related to dyspepsia-like symptoms. In the worst-case scenario, this may cause gastric outlet or intestinal obstruction which eventually requires surgery. Case presentation We present a 36-year-old lady with underlying end-stage renal failure (ESRF) and undiagnosed mental health issues who was treated for recurrent episodes of gastritis. Imaging modalities revealed intragastric foreign body ingestion which is consistent with gastric trichobezoar. She eventually underwent laparotomy and gastrotomy to remove the foreign body. Postoperatively, she was referred and followed-up by the psychiatric team. Conclusion Gastric trichobezoar has strong associations with psychiatric disorders. With the co-existence of an ESRF, uraemia might contribute to the aetiology of the trichotillomania and trichophagia. Open surgery is the choice of definitive management especially if bezoars are larger. Should the recurrence be remitted, a biopsychosocial modality and regular haemodialysis is the most sustainable approach to ensure the behaviour does not persist.

Surgical Management of Massive Metal Bezoar

“…The term bezoar is derived from the Arabic term (bezehr) or (bedzher), which goes historically to more than 2000 years ago. Bezoar can be defined as a foreign body resulting from an accumulation of indigestible materials commonly found as a mass within the gastrointestinal tract (GIT) [ 1 , 2 ]. They are most commonly found in the stomach; however, they can be found in the esophagus, small bowel, and colon.…”

“…Lactobezoars are seen in infants, and it's mainly formed from undigested milk and mucus. Metal bezoars are the least common type [ 1 , 2 ]. Ingestion of a massive number of sharp nails is an example of metal bezoars with few cases have been reported in the literature.…”

“…Foreign body (FB) ingestion is common within the pediatric age group, and to a lesser extent in adults, especially those with an underlying psychiatric illness [1][2][3]. These indigestible foreign bodies accumulate within the gastrointestinal tract and are known as bezoars.…”

“…Ingestion of a massive number of sharp nails is an example of metal bezoars with few cases have been reported in the literature. Those patients usually require intervention as they carry a risk of complications in the form of perforation, bleeding, and obstruction [1][2][3].…”

Trichobezoar: A case report of a double gastric and ilial localization revealed by an occlusion

“…A bezoar is an agglutination of ingested materials forming an indigestible and insoluble mass inside the gastrointestinal tract. There are several types of Bezoars, namely: phytobezoars, lactobezoars, pharmacobezoars and trichobezoars [1] , [2] .Trichobezoars formed by ingested hair occurs in 5–10% of patients with trichophagy, which is present in only 1% of those with trichotillomania. It also occurs following the ingestion of artificial hair.…”