Teaching Case

A 15 year old female patient was presented to our institution with abdominal pain and elevated pancreatic enzymes.

The 15 year old female patient was presented to our department vomiting and with elevated pancreatic enzymes and abdominal pain. Single contrast media upper gastrointestinal study showed a stomach distention and filling of a posterior image characteristic for a big duodenal diverticulum. CT examination revealed finally a trichobezoar in the stomach and in the duodenal diverticulum, rising from the duodenum second medial side portion surrounded by annular pancreas. The trichobezoar was removed by surgery.

Bezoars are concretions of fibers and usually found in stomach, jeujunum or proximal ileum, rarely in duodenum. Clinical signs and symptoms are nausea, fever, abdominal pain and elevated leukocyte count; the major predisposing factors are gastric resection or peptic ulcer surgery. They are removed by surgery or fragmented by endoscopy. Trichobezoar, a less common type, is maked of hair. Single contrast media upper GI study and CT are useful to investigate the alimentary tract. MDCT diagnostic value consists of the possibility to have reformatted images (MPR, MIP, VR), obtain the difference of the anatomical structures with the use of intravenous contrast and make diagnosis without oral contrast.