Trichobezoar Presenting With Chief Complaints of Chest Pain, Weight Loss, and Gastrointestinal Bleeding

Abstract

Abdominal pain is a frequent presenting complaint in pediatric patients seeking acute medical care. We report the case of an adolescent female who presented with nonspecific complaints of chest pain, faintness, and weight loss and whose diagnosis was determined only after the disclosure of trichophagia.

Weight Loss and Decreased Appetite in an 11-Year-Old Girl

“…A trichobezoar is an accumulation of ingested human hair (or more crudely, a "hairball") in the digestive tract (Macksey, 2006). The formation of this type of bezoar has been linked to an impulse control disorder called trichotillomania or hair pulling (Ramirez, Pathak, Webber, & McLario, 2011). Bezoars, although diagnosed in many age groups, are most commonly found in adolescent patients, and over 90% of patients are female (Coskun, Bozkurt, & Ersoy, 2005).…”

“…Correlating physical examination, history, and plain abdominal films should prompt a computed tomographic scan, which is diagnostic for up to 97% of bezoars (Lee, 1996). Although the treatment for some types of bezoars can be done without surgery, such as treating phytobezoars (vegetable matter) using medications such as cellulose to break up the materials and allow them to pass through the digestive tract, surgery is indicated in the case of larger bezoars, which cannot be removed endoscopically (Ramirez et al, 2011). In these cases, bowel contents and the abdomen are thoroughly examined for additional damage or contamination.…”

“…After the removal of the trichobezoar, it is also important to consider psychological therapy for the underlying condition, trichotillomania, or other psychological concerns. In some cases, late onset of trichotillomania (after the age of 10 years) may be associated with additional psychological disorders requiring long-term therapy (Ramirez et al, 2011).…”