Trichotillomania and Trichophagia Leading to Trichobezoar

Abstract

A 14-year-old female presented with the complaints of loss of hair, scalp pruritus, and pain in the abdomen. On careful work-up, she was found to have trichotillomania as well as trichophagia. Investigations also revealed a trichobezoar which completely filled the stomach. Hemogram showed moderate hypochromic anemia. Her detailed psychiatric profile showed a few additional features like obsessive hand washing, knuckle cracking, nose picking and body rocking. Her trichobezoar was removed surgically, and she had an uneventful post-operative recovery. She is being maintained on fluoxetine and is doing well. The role of a multi-disciplinary approach to trichotillomania patients is highlighted.

Rapunzel Syndrome: A Comprehensive Review of an Unusual Case of Trichobezoar

“…Case reports of children with trichobezoars or Rapunzel syndrome are rare, and many link the trichophagia to early childhood neglect or abuse, 21 psychiatric conditions, 21,22 mental retardation 23,24 or bereavement. 2,25 Although studies of the pharmacotherapy of trichotillomania remain inconsistent, some patients seem to respond to fluoxetine or other serotonin reuptake inhibitors.…”

A Rare Case of Small Bowel Obstruction Due to Primary Trichobezoar

“…Patients are usually anaemic, it is well established that iron deficiency anaemia is rather a result not cause of trichophagy. Iron levels are normal in most patients with trichotillomania [2]. Conventional radiography shows a mass of opaque soft tissue in swollen stomach.…”

“…More than 90% trichobezoars are found in young girls between 15 and 20 years of age. About 10% of patients have shown psychiatric abnormalities termed as trichotillomania or mental retardation [2]. Bezoars mostly originate in the stomach.…”

Síndrome de Rapunzel: tricobezoar gastroduodenal

“…La tricofagia es una perversión del apetito determinada por alteraciones afectivas, aislamiento social, angustia y retraso psicomotor ( [20][21][22] ). Precisamente en el caso que comentamos, la paciente negó el dato de tricofagia; en realidad, el diagnóstico fue hecho por endoscopia y el hallazgo de alopecia estuvo ausente en la historia clínica, como suele ocurrir en la mayoría de los casos.…”