Gastric trichobezoar

Clinical History

A 17-year-old girl presented to the ER complaining of abdominal pain. A hard mass in her epigastrium extending to the lower abdomen was diagnosed.

Imaging Findings

A CT scan was performed which showed a well-defined mass inside the distended stomach, with mixed density and pockets of gas. The parenchymal organs were normal. An upper GI gastrografin follow-through confirmed the presence of an intraluminal filling defect of the stomach without constant site of attachment to the wall.

Discussion

After the initial imaging findings, a careful history of the patient was obtained, during which she admitted to nibbling on her hair when she was studying. As shown in the image findings, this was taking place for quite a long time, because the trichobezoar mass was very large. Trichobezoar is a wad of swallowed hair, also called a hairball. Trichobezoars can sometimes be found to cause blockage of the digestive system, especially at the exit of the stomach, as was this case.
A bezoar is a tightly packed collection of undigested material that is unable to exit the stomach. Most bezoars are of indigestible organic matter such as hair-trichobezoars; or vegetable and fruit – phytobezoars; or a combination of both. Trichobezoars commonly occur in patients with psychiatric disturbances who chew and swallow their own hair. Only 50% will have history of trichophagia. Trichobezoars have been described in the literature and they comprise 55% of all bezoars. In very rare cases, the Rapunzel syndrome, hair extends through the pylorus into the small bowel causing symptom and sign of partial or complete gastric outlet obstruction.
In our case the diagnosis was made very late and surgery was the only option.
Suspect a bezoar whenever children or psychiatric patients present with abdominal pain and always inspect the contents of the stomach.

Differential Diagnosis List

Final Diagnosis

Gastric trichobezoar

URL:	https://www.eurorad.org/case/9147
DOI:	10.1594/EURORAD/CASE.9147
ISSN:	1563-4086