Trichobezoar without a clear manifestation of trichotillomania

Abstract

Trichophagia is a compulsive condition characterized by eating hair, mostly seen in adolescent females. Persistence of ingestion of hair over many years results in the formation of trichobezoar. Surgical intervention is often needed in the management of large trichobezoars. We present a case of a 23 year old female with trichophagia which led to the formation of gastric trichobezoar. The patient reported with complaints of pain in abdomen for past 1–2 years, and loss of appetite and vomiting post meals for 6 months. On detailed examination, a diagnosis of trichobezoar was formed which was removed by laparotomy with gastrotomy under general anaesthesia. Psychiatric evaluation revealed a history of fluctuating mood symptoms during her childhood and depressive symptomatology presently without any associated urge of plucking hair and subsequent gratification. Hence, the management of the disease requires proper liaison between the surgeon, psychiatrist, and caregivers of the patient; and regular psychiatric follow-up and treatment of the underlying psychopathology to prevent the recurrent formation of bezoar.

Trichobezoar Found Accidently while Diagnosing Resistance to Thyroid Hormone

“…They were discovered in 1779 during an autopsy of a patient who died of gastric perforation [10]. Nowadays, they are described in the surgical literature, and fewer cases are found in psychiatric sources [14]. Trichobezoars can appear asymptomatic or cause a variety of symptoms and signs from the gastrointestinal tract, such as nausea, vomiting, flatulence, loss of appetite, abdominal pain, halitosis, or ulceration that leads to bleeding and/or perforation [2, 10].…”

“…The findings of the clinical examination with trichobezoar are diverse and depend on the stage at which the bezoar is formed [3]. Most trichobezoars remain asymptomatic during the initial stages [14]. It may lead to delay in diagnosis or even misdiagnosis.…”

“…As described above, clinical symptoms related to trichobezoars are characterized by late onset and lack of specificity, leading to late diagnosis. As a result, diagnostic procedures are commonly performed due to acute abdominal symptoms or abnormalities in abdominal palpation [14].…”

“…Psychiatric treatment is an inherent part of follow-up after surgical removal of trichobezoar to avoid another accident. It includes both medications and psychotherapy [3, 14]. Drugs such as selective serotonin reuptake inhibitors, olanzapine, clomipramine, Nacetylcysteine, naltrexone, topiramate, dronabinol, and atypical neuroleptics are effective [14, 18].…”

Trichophagia as a cause of acute appendicitis in a patient with bipolar disorder

“…Trichophagia is usually associated with anxiety, depressive disorders, obsessive-compulsive disorder, anorexia nervosa, and trichotillomania. [ 11 ] Rapunzel syndrome is a common result of this disorder which is due to a trichobezoar formation within the stomach extending up to the small bowel. [ 12 ] Rarely, as seen in this case, trichobezoar formation may occur in the distal intestine and may cause appendiceal obstruction, which can cause acute appendicitis.…”