Trichobezoar: a rare clinical rendezvous with twin sisters

Authors

  • Abdulrahman Almuawi Department of Pediatric Surgery, Maternity and Child Hospital, Bisha, Saudi Arabia
  • Omar Alsamahy Department of Pediatric Surgery, Al Azhar University Cairo, Egypt
  • Mir Fahiem-Ul-Hassan Department of Pediatric Surgery, Maternity and Child Hospital, Bisha, Saudi Arabia
  • Brahemi Abdelhamid Department of Pediatric Surgery, Maternity and Child Hospital, Bisha, Saudi Arabia

DOI:

https://doi.org/10.18203/2349-2902.isj20205906

Keywords:

Trichobezoar, Trichotllomania, Laparotomy

Abstract

Trichobezoar is very uncommon in the pediatric age group. Till now no familial predisposition has been reported. We hereby report our clinical experience with eight years old twin sisters one of whom had a huge gastric trichobezoar and other one had a history of trichotillomania with recurrent vomiting and weight loss. An eight years old female child, one of the twin, presented with history of recurrent vomiting. Abdominal examination revealed firm mass in epigastric region. X-ray abdomen showed the transverse colon pushed down. Ultrasonography revealed echogenic mass in the stomach. Preoperative diagnosis of trichobezoar was achieved by a computed tomography (CT) scan. Laparotomy was done through the midline abdominal incision after initial session of resuscitation. A huge mass of hair was retrieved from the stomach part of which was passing into the duodenum. Patient was found to have underlying trichotillomania and obsessive compulsive disorder. As the patient was one of the twins, other sibling was called and evaluated for the mental health. Interestingly, she was found to have trichotillomania and trichophagia. Examination revealed sparse scalp hair. X-ray and the sonography of the abdomen were normal. Patient was advised endoscopic examination which the guardian of the patient refused. Patient was put on outpatient department (OPD) follow up after psychiatric counselling. Trichobezoar should be suspected in a pediatric patient of gastrointestinal symptoms, epigastric mass and anemia with history of trichophagia. Open surgery gives optimum results. Sibling of an affected twin must be evaluated on the similar lines and managed accordingly.

Author Biographies

Abdulrahman Almuawi, Department of Pediatric Surgery, Maternity and Child Hospital, Bisha, Saudi Arabia

Chief

Pediatric Surgery & Neonatal Surgery

Maternity & Child Hospital Bisha Saudi Arabia

Omar Alsamahy, Department of Pediatric Surgery, Al Azhar University Cairo, Egypt

Associate Professor
Pediatric Surgery Department
Al-Azhar University. Cairo'Egypt
Phone +2 01221754624
+966548107540

Mir Fahiem-Ul-Hassan, Department of Pediatric Surgery, Maternity and Child Hospital, Bisha, Saudi Arabia

Specialist

Department of Pediatric Surgery

Maternity & Child Hospital. Bisha, Saudi Arabia.

Phone 0501689934

Email. drfaheemandrabi@gmail.com

Brahemi Abdelhamid, Department of Pediatric Surgery, Maternity and Child Hospital, Bisha, Saudi Arabia

Specialist

Department of Pediatric Surgery

Maternity & Child Hospital. Bisha, Saudi Arabia.

Phone 055800942

References

Aoi S, Kimura K, Tsuda T. Double and synchronous trichobezoars causing small-bowel obstruction and detected by multidetector computed tomography: report of two cases. Surg Today. 2015;45(5):634-7.

Morris BB, Shah ZK, Shah PP. An intragastric trichobezoar: computerised tomographic appearance. J Postgraduate Med. 2000;46(2):94.

Seo JY, Kim MY, Noh JH, Kim CD, Park JO, Choi GC. A case of gastric trichobezoar causing psychiatric problems. Korean J Pediatr. 2009;52(10):1167-70.

Jensen AR, Trankiem CT, Lebovitch S, Grewal H. Gastric outlet obstruction secondary to a large trichobezoar. J Pediatr Surg. 2005;40(8):1364-5.

Jiledar SG, Mitra SK. Gastric perforation secondary to recurrent trichobezoar. Indian J Pediatr. 1996;63(5):689-91.

Jensen AR, Trankiem CT, Lebovitch S, Grewal H. Gastric outlet obstruction secondary to a large trichobezoar. J Pediatr Surg. 2005;40(8):1364-5.

Alsafwah S, Alzein M. Small bowel obstruction due to trichobezoar: role of upper endoscopy in diagnosis. Gastroint Endosc. 2000;52(6):784-6.

Khattala K, Boujraf S, Rami M, Elmadi A, Afifi A, Sbai H, Harandou M, Bouabdallah Y. Trichobezoar with small bowel obstruction in children. Ann Pediatr Surg. 2008;4(1-2):51-4.

Gorter RR, Kneepkens CM, Mattens EC, Aronson DC, Heij HA. Management of trichobezoar: case report and literature review. Pediatr Surg Int. 2010;26(5):457-63.

Poerwosusanta H, Halim PG, Sitompul A, Wibowo AA. Combined endoscopy-laparoscopy-gastrostomy extraction for Rapunzel syndrome. J Pediatr Surg Case Rep. 2020;61:101631.

Gupta A, Mittal D, Srinivas M. Gastric trichobezoars in children: Surgical overview. Int J Trichol. 2017;9(2):50.

Wolski M, Gawłowska-Sawosz M, Gogolewski M, Wolańczyk T, Albrecht P, Kamiński A. Trichotillomania, trichophagia, trichobezoar-summary of three cases. Endoscopic follow up scheme in trichotillomania. Psychiatr Pol. 2016;50(1):145-52.

Al Wadan AH, Al Kaff H, Al Senabani J, Al Saadi AS. 'Rapunzel syndrome'trichobezoar in a 7-year-old girl: a case report. Cases J. 2008;1(1):1-3.

Kırpınar İ, Kocacenk T, Koçer E, Memmi N. Recurrent trichobezoar due to trichophagia: a case report. General Hospital Psychiatr. 2013;35(4):439-41.

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Published

2020-12-28

Issue

Section

Case Reports