03/11/2025
A giant gastric trichobezoar (hair ball)!
A bezoar is a tightly packed collection of undigested material that is unable to exit the stomach, most being hair-trichobezoars. This 16-year-old female with a positive psychiatric history of OCD had uncontrollable repetitive thoughts with urge to pull (trichotillomania) and eat hair (trichophagia). She presented with epigastric pain for the past six months with progressive loss of apetite and early satiety. Vomiting with increasing frequency for the last two months. Lean patient with hair cropped short. On examination, soft, non-tender abdomen with no distention.
Firm to hard mass palpable, craniocaudally extending from the below the subcostal margins to the infraumbilical region and horizontally between both midclavicular lines. Mass was mobile and moved with respiration. No other positive findings on physical examination. XRay Abdomen showed a radio-opaque shadow occupying most of the abdominal cavity. CECT showed a large intraluminal mass in the stomach extending up to the second part of duodenum consistent with a gastric bezoar. Laparotomy and extraction of trichobezoar done successfully.
The bezoar had formed into a cast of the stomach and the first and second parts of the duodenum. Uneventful post-op course. Patient discharged over to psychiatric care for further management.
Case by Medical Information 16
