Management of trichobezoar: case report and literature review

Abstract

Trichobezoars (hair ball) are usually located in the stomach, but may extend through the pylorus into the duodenum and small bowel (Rapunzel syndrome). They are almost always associated with trichotillomania and trichophagia or other psychiatric disorders. In the literature several treatment options are proposed, including removal by conventional laparotomy, laparoscopy and endoscopy. We present our experience with four patients and provide a review of the recent literature. According to our experience and in line with the published results, conventional laparotomy is still the treatment of choice. In addition, psychiatric consultation is necessary to prevent relapses.

Trichobezoar in Paediatrics: An Uncommon Cause of Gastric Outlet Obstruction

“…Endoscopy is the diagnostic technique of choice for gastric and esophageal bezoars and has therapeutic potentials [1]. Endoscopy can help a surgeon distinguish between a trichobezoar and another foreign body that can be broken apart and removed endoscopically [10].…”

“…Advantages of laparoscopic removal are an improved cosmetic appearance, fewer postoperative complications, and reduced hospital stay [10]. Laparoscopic removal of an entire bezoar is difficult without spillage of hairs into the peritoneal cavity [11].…”

“…Open surgery is the most common technique used for trichobezoar removal. Some physicians consider conventional laparotomy to be the treatment of choice [10]. Surgical removal is accomplished by gastrotomy or enterotomy [5].…”

Tale of a hairy tail: Rapunzel Syndrome

“…The entity remains asymptomatic unless obstruction of either the stomach or the small bowel precipitates symptoms. Other reported manifestations include bleeding, perforation, intussusception, pancreatitis and obstructive jaundice [3]. Although endoscopic removal or dissolution with coca-cola have been described, we did not venture with these modalities due to the presence of a large ulcer possibly due to the pressure necrosis of gastric mucosa [4].…”

Trichobezoar with Gastric Perforation

“…[2] Gastric trichobezoar is the most common entity and the underlying etiology is usually a psychiatric disorder. [3] Trichobezoar is relatively a rare surgical finding. In approximately 1% of the patients with trichophagia, a trichobezoar is seen to develop.…”