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

Abstract

Introduction and importance A bezoar is an agglutination of ingested materials forming an indigestible and insoluble mass inside the gastrointestinal tract. Trichobezoars formed by ingested hair are rare. The stomach tends to be the typical location. In some cases there is an extension to the duodenum, jejunum or even to the colon and it is called Rapunzel syndrome. Case presentation We present a case of an occlusion due to double trichobezoars in 17 years old woman who underwent an extraction by enterotomy and gastrotomy. Clinical discussion Trichobezoar is a compact conglomeration of swallowed hair and makes up less than 6% of all bezoars. It appears in young women under 20 years of age who carry psychiatric or chronic metabolic diseases that can alter the behavioral balance. Physical examination is often poor in uncomplicated forms: forms without peritonitis or occlusion or hemorrhage or appendicitis or pancreatitis but it may reveal a well-limited, smooth, firm, and mobile epigastric mass. For uncomplicated forms or forms complicated by hemorrhage, the reference examination requested in the first line remains the esophagogastroduodenoscopy (EGD) which allows a dual role both diagnostic and therapeutic. Computed Tomography (CT) remains the preferred imaging modality requested urgently in case of an occlusion or peritonitis presentation. Endoscopic extraction represents the therapeutic approach for uncomplicated forms but surgical treatment remains the main therapeutic means of trichobezoar. Conclusion Trichobezoars are rare and present both diagnostic and therapeutic challenge. Laparotomy remains the most successful surgical treatment although laparoscopy currently appears to have promising results in expert hands. A post-operative pscychologic management is essential to correct psychobehavioral disorders of patients to prevent recurrence.

Bezoar misto gastrojejunal - Relato de caso

“…O tratamento com a laparotomia é considerado a melhor alternativa para a resolução do quadro, sendo indicada principalmente em casos de bezoares de grande volume, em que a incisão depende de cada caso. Certamente, a laparotomia possibilita a análise de todo o trato digestivo, a extração do bezoar gástrico através de uma gastrotomia, assim como a remoção de possíveis fragmentos bloqueados à distância do estômago por meio de uma ou mais enterotomias (Ben-Khalifa et al, 2022). Na paciente aqui relatada não se detectou fragmentos.…”

“…Portanto, é indiscutível o acompanhamento multidisciplinar e da família no pósoperatório (Ben-Khalifa et al, 2022).…”

Duodenal diastatic perforation due to double gastric and jejunal trichobezoar in a patient with Rapunzel syndrome

“…Rapunzel syndrome is a rare clinical entity in which a trichobezoar is produced in the stomach, extending in the form of a tail into the duodenum after the ingestion of hair. It occurs in young patients with trichotillomania and trichophagia (1). Symptoms are nonspecific and may include abdominal pain, weight loss or anemia (2).…”