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Category: Volume 11 Issue 08 August 2023
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Title: 4 years institutional experience in the management of Trichobezoar: About 5 Cases

Authors: Nitin Jain M.Ch, Simmi K Ratan M. Ch, Shasanka Shekhar Panda M. Ch, Sujoy Neogi M. Ch

 DOI: https://dx.doi.org/10.18535/jmscr/v11i8.04

Abstract

Background: Trichobezoar is an uncommon clinical entity in which ingested hair mass accumulates within the digestive tract. Trichobezoars are usually located in the stomach, but may extend through the pylorus into the duodenum and small bowel (Rapunzel syndrome). This entity is usually associated with trichotillomania and trichophagia or other psychiatric disorders. It is generally observed in children and young females with psychological disorders. Untreated cases may lead to grave complications. We present our experience with five patients and provide a review of the recent literature.

Material and Methods: We retrospectively analysed the clinical data of five patients treated for trichobezoar in pediatric surgery department during 4-year-period between 2018 and 2022. Their medical charts were reviewed with respect to symptoms, diagnostic procedures including any Imaging (abdominal ultrasonography and abdominal computed tomography) or upper GI endoscopy and treatment. 

Results: Our study involved 5 girls aged 7 to 12 years. All cases presented with symptoms of epigastric pain associated with vomiting of recently ingested food and weight loss in three cases. Physical examination revealed a hard epigastric mass in all cases. The trichobezoar was confined to the stomach in 4 cases. An extension into the jejunum was observed in 1 case. All patients were surgically treated. In one case, the attempt of endoscopic extraction failed and patient was later operated. On surgical exploration gastrotomy was done in all the patients to extract the hair bezoar even those with jejunal extension. All patients proved to suffer from trichophagia and referred to a child psychiatrist or psychologist for regular follow-up. No recurrences have been reported.

Conclusion: According to our experience and in line with the published results, conventional laparotomy is still the treatment of choice. The literature provides no evidence of superiority of endoscopy or laparoscopy. After successful treatment, psychiatric consultation is imperative to prevent recurrence and improve long term prognosis.

Keywords: Rapunzel syndrome, Trichobezoar, Trichotillomania, Gastrotomy, Endoscopy.

References

  1. Diefenbach GJ, Reitman D, Williamson DA (2000) Trichotillomania: a challenge to research and practice. Clin Psychol Rev 20:289–309
  2. Carr JR, Sholevar EH, Baron DA (2006) Trichotillomania and trichobezoar: a clinical practice insight with report of illustrative case. J Am Osteopath Assoc 106:647–652
  3. Bouwer C, Stein DJ (1998) Trichobezoars in trichotillomania: case report and literature review. Psychosom Med 73:653–656
  4. Sehgal VN, Srivastava G (2006) Trichotillomania ± trichobezoar: revisited. J EurAcad Dermatol Venereol 20:911–915
  5. Debakey M, Oschner A (1939) Bezoars and concretions, comprehensive review of literature with analysis of 303 collected cases and presentation of 8 additional cases. Surgery 5:132–160
  6. Vaughan ED Jr, Sawyers JL, Scott HW Jr (1968) The Rapunzel syndrome. An unusual complication of intestinal bezoar. Surgery 63:339–343
  7. Naik S, Gupta V, Rangole A, Chaudhary AK, Jain P, Sharma AK (2007) Rapunzel syndrome reviewed and redefined. Dig Surg 24:157–161
  8. Palanivelu C, Rangarajan M, Senthilkumar R, Madankumar MV (2007) Trichobezoars in the stomach and ileum and their laparoscopy-assisted removal: a bizarre case. Singapore Med J 48:37–39
  9. Khattak S, Kamal A (2004) Trichobezoar. Gomal J Med Sci 2:25–26
  10. Hoover K, Piotrowski J, Pierre K, Katz A, Goldstein AM (2006) Simultaneous gastric and small intestinal trichobezoars—a hairy problem. J Pediatr Surg 41:1495–1497
  11. John NP, Timothy JU. Bailey and Love’s Short Practice of Surgery. 26th ed. Boca Raton, FL: CRC Press; 2013. Stomach and duodenum. In: Williams NS, Bulstrode CJK, O’Connell P.R. eds; pp. 1023–1057.
  12. Abou Azar S, Wehbe MR, Jamali S, Hallal A. Small bowel obstruction secondary to a metamucil bezoar: Case report and review of the literature. Case Rep Surg. 2017;2017:2702896.
  13. Dalshaug GB, Wainer S, Hollaar GL. The Rapunzel syndrome (trichobezoar) causing atypical intussusception in a child: a case report. J Pediatr Surg. 1999;34(3):479–80. 
  1. Khan S, Khan IA, Ullah K, Khan S, Wang X, Zhu LP, et al. Etiological aspects of intragastric bezoars and its associations to the gastric function implications: A case report and a literature review.Medicine (Baltimore) 2018;97:e11320. 
  2. Katsinelos P, Pilpilidis I, Chatzimavroudis G, Katsinelos T, Lazaraki G, Fasoulas K, et al. Huge gastric bezoar caused by honeycomb, an unusual complication of health faddism: A case report.Cases J. 2009;2:7077.
  3. Blejc Novak A, Zupančič Ž, Plut D, Gvardijančič D, Homan M. Rapunzel syndrome: A rare form of trichobezoar in the stomach with some extension into the small intestine. Acta Dermatovenerol Alp Pannonica Adriat. 2018;27:155–7. 
  4. Gorter R, Kneepkens C, Mattens E, Aronson D, Heij H. Management of trichobezoar: Case report and literature review.Pediatr Surg Int. 2010;26:457–63.
  5. Palanivelu C, Rangarajan M, Senthilkumar R, Madankumar MV. Trichobezoars in the stomach and ileum and their laparoscopy-assisted removal: A bizarre case.Singapore Med J.2007;48:e37–9.

Corresponding Author

Dr Simmi K Ratan

Dir. Professor & Head, Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi-110002, India