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A CASE OF
TRICHOBEZOAR
IN A TEENAGE GIRL
Dr. Mohammed Sultan ROD Surgery
Dr. Mohamad Al-Gailani Consultant Surgeon
Nuzha
THE THIRD SCIENTIFIC CONFERENCE OF AHH, 23RD OF FEBRUARY 2023
DEFINITIONS
 TRICHOBEZOAR: an intraluminal mass in the stomach or intestine composed of
undigested matted swallowed hair and food particles.
 Human hair is resistant to digestion as well as peristalsis due to its smooth
surface
 Therefore, it accumulates between the mucosal folds of the stomach.
 TRICHOPHAGIA: the act of repeated ingestion of hair
 TRICHOTILLOMANIA: compulsive hair pulling
 RAPUNZEL SYNDROME: is when the hair extends through the pylorus to the
duodenum and small bowel.
A CASE OF TRICHOBEZOAR IN A TEENAGE GIRL
2
EPIDEMIOLOGY
 Trichobezoar primarily occurs in adolescent female patients
with trichophagia , trichotillomania and other underlying
psychiatric disorders.
Trichobezoar is a rare obstructive condition almost exclusively
(up to 90%) seen in young females between the age of 10 – 19
years .
The site of hair pulling is most commonly from the scalp, but
not exclusively, as it can occur from the eyelashes, eyebrows
and pubic area.
A CASE OF TRICHOBEZOAR IN A TEENAGE GIRL
3
CASE PRESENTATION
 14-year-old female presented initially to Internal Medicine clinic
 Main Complaint: gastric discomfort, persistent nausea and feeling of
an abdominal mass. Otherwise fit with no history of weight loss.
 Physical Examination:
 Healthy teenager with partial alopecia noticed.
 Abdomen was soft with palpable hard mass on the left upper outer
quadrant
A CASE OF TRICHOBEZOAR IN A TEENAGE GIRL
4
MANAGEMENT
 Ultrasonography:
 Abdominal Ultrasonography reported a mobile gastric mass mostly
trichobezoar.
 Patient was then referred to Gastroenterologist:
 CT Scan ordered.
 Gastroscopy ordered.
 Gastroscopy by Gastroenterologist:
 Trichobezoar confirmed & attempts for its removal was made but was of
large size to be evacuated endoscopically.
 Surgical consultation to Dr. Mohammed Gailani was made for operative
intervention.
A CASE OF TRICHOBEZOAR IN A TEENAGE GIRL
5
“Dilated stomach with sizable heterogeneous mass (50x88x122 mm) inside the
stomach”
CT Scan Abdomen
A CASE OF TRICHOBEZOAR IN A TEENAGE GIRL
6
SURGICAL CONSULTATION
DR MOHAMAD AL-GAILANI
 Full history & Examination confirming the epigastric hard mass
 Patient admitted pulling & swallowing her hair!
 Advice to family to proceed with laparotomy and removal of the trichobezoar.
 Family informed that she would need psychological counselling afterwards.
 16th of January 2024: Laparotomy, gastrotomy and removal of a large trichobezoar
 Discharged well on the 3rd post operative day.
 Follow up 14 days post operatively: patient well, wounds healed.
 Again, family advised to arrange an appointment with the psychiatry clinic.
A CASE OF TRICHOBEZOAR IN A TEENAGE GIRL
7
16/1/2024 LAPAROTOMY, GASTROTOMY
TRICHOBEZOAR
A CASE OF TRICHOBEZOAR IN A TEENAGE GIRL
8
A CASE OF TRICHOBEZOAR IN A TEENAGE GIRL
9
16/1/2024
THE REMOVED TRICHOBEZOAR
TRICHOBEZOAR:
CLINICAL PRESENTATION & COMPLICATIONS
 Ranges from non-specific abdominal or epigastric pain to a range of
complications including gastric perforation.
 Loss of appetite, weight loss, abdominal pain and vomiting.
 Patients usually seek medical attention and develop symptoms by the
time the trichobezoar is of large size and occupies a large portion of the
gastric space.
 Intestinal obstruction
 Erosion & perforation
 Intussusception
 Obstructive jaundice
 In rare cases Pancreatitis.
A CASE OF TRICHOBEZOAR IN A TEENAGE GIRL
10
TRICHOBEZOAR:
DIAGNOSIS
 History & Exam in a vulnerable patient: epigastric mass
 US
 Gastroscopy
 Computed tomography (CT) is the mainstay diagnostic modality
A CASE OF TRICHOBEZOAR IN A TEENAGE GIRL
11
TRICHOBEZOAR:
TREATMENT OPTIONS
 The objective is the mechanical removal of trichobezoar and the prevention of
recurrences with psychotherapy.
 Management options include endoscopic, laparoscopic or surgical removal by
laparotomy .
 Gorter et al* in a retrospective review of 108 cases of trichbezoar, evaluated the
available management options:
 5 % of Endoscopic attempts for removal were successful
 75 % of Laparascopic attempts were successful
 However, laparotomy was 100% successful and thus is the management of
choice.
 *Management of trichobezoar: case report and literature review R R Gorter 1, C M F Kneepkens, E C J L
Mattens, D C Aronson, H A Heij Pediatr Surg Inter. 2010 May;26(5):457-63
A CASE OF TRICHOBEZOAR IN A TEENAGE GIRL
12
“
”
Thank You
THE THIRD SCIENTIFIC CONFERENCE OF AHH, 23RD OF FEBRUARY 2023
A CASE OF TRICHOBEZOAR IN A TEENAGE GIRL
Dr. Mohammed Sultan ROD Surgery
Dr. Mohamad Al-Gailani Consultant Surgeon
‫ا‬
‫الكيالني‬ ‫محمد‬ ‫لدكتور‬
‫الجراحة‬ ‫قسم‬ ‫رئيس‬
‫الحمادي‬ ‫مستشفى‬
‫الرياض‬
‫السعودية‬ ‫العربية‬ ‫المملكة‬
14

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A case of Trichobezoar in a teenage female

  • 1. A CASE OF TRICHOBEZOAR IN A TEENAGE GIRL Dr. Mohammed Sultan ROD Surgery Dr. Mohamad Al-Gailani Consultant Surgeon Nuzha THE THIRD SCIENTIFIC CONFERENCE OF AHH, 23RD OF FEBRUARY 2023
  • 2. DEFINITIONS  TRICHOBEZOAR: an intraluminal mass in the stomach or intestine composed of undigested matted swallowed hair and food particles.  Human hair is resistant to digestion as well as peristalsis due to its smooth surface  Therefore, it accumulates between the mucosal folds of the stomach.  TRICHOPHAGIA: the act of repeated ingestion of hair  TRICHOTILLOMANIA: compulsive hair pulling  RAPUNZEL SYNDROME: is when the hair extends through the pylorus to the duodenum and small bowel. A CASE OF TRICHOBEZOAR IN A TEENAGE GIRL 2
  • 3. EPIDEMIOLOGY  Trichobezoar primarily occurs in adolescent female patients with trichophagia , trichotillomania and other underlying psychiatric disorders. Trichobezoar is a rare obstructive condition almost exclusively (up to 90%) seen in young females between the age of 10 – 19 years . The site of hair pulling is most commonly from the scalp, but not exclusively, as it can occur from the eyelashes, eyebrows and pubic area. A CASE OF TRICHOBEZOAR IN A TEENAGE GIRL 3
  • 4. CASE PRESENTATION  14-year-old female presented initially to Internal Medicine clinic  Main Complaint: gastric discomfort, persistent nausea and feeling of an abdominal mass. Otherwise fit with no history of weight loss.  Physical Examination:  Healthy teenager with partial alopecia noticed.  Abdomen was soft with palpable hard mass on the left upper outer quadrant A CASE OF TRICHOBEZOAR IN A TEENAGE GIRL 4
  • 5. MANAGEMENT  Ultrasonography:  Abdominal Ultrasonography reported a mobile gastric mass mostly trichobezoar.  Patient was then referred to Gastroenterologist:  CT Scan ordered.  Gastroscopy ordered.  Gastroscopy by Gastroenterologist:  Trichobezoar confirmed & attempts for its removal was made but was of large size to be evacuated endoscopically.  Surgical consultation to Dr. Mohammed Gailani was made for operative intervention. A CASE OF TRICHOBEZOAR IN A TEENAGE GIRL 5
  • 6. “Dilated stomach with sizable heterogeneous mass (50x88x122 mm) inside the stomach” CT Scan Abdomen A CASE OF TRICHOBEZOAR IN A TEENAGE GIRL 6
  • 7. SURGICAL CONSULTATION DR MOHAMAD AL-GAILANI  Full history & Examination confirming the epigastric hard mass  Patient admitted pulling & swallowing her hair!  Advice to family to proceed with laparotomy and removal of the trichobezoar.  Family informed that she would need psychological counselling afterwards.  16th of January 2024: Laparotomy, gastrotomy and removal of a large trichobezoar  Discharged well on the 3rd post operative day.  Follow up 14 days post operatively: patient well, wounds healed.  Again, family advised to arrange an appointment with the psychiatry clinic. A CASE OF TRICHOBEZOAR IN A TEENAGE GIRL 7
  • 8. 16/1/2024 LAPAROTOMY, GASTROTOMY TRICHOBEZOAR A CASE OF TRICHOBEZOAR IN A TEENAGE GIRL 8
  • 9. A CASE OF TRICHOBEZOAR IN A TEENAGE GIRL 9 16/1/2024 THE REMOVED TRICHOBEZOAR
  • 10. TRICHOBEZOAR: CLINICAL PRESENTATION & COMPLICATIONS  Ranges from non-specific abdominal or epigastric pain to a range of complications including gastric perforation.  Loss of appetite, weight loss, abdominal pain and vomiting.  Patients usually seek medical attention and develop symptoms by the time the trichobezoar is of large size and occupies a large portion of the gastric space.  Intestinal obstruction  Erosion & perforation  Intussusception  Obstructive jaundice  In rare cases Pancreatitis. A CASE OF TRICHOBEZOAR IN A TEENAGE GIRL 10
  • 11. TRICHOBEZOAR: DIAGNOSIS  History & Exam in a vulnerable patient: epigastric mass  US  Gastroscopy  Computed tomography (CT) is the mainstay diagnostic modality A CASE OF TRICHOBEZOAR IN A TEENAGE GIRL 11
  • 12. TRICHOBEZOAR: TREATMENT OPTIONS  The objective is the mechanical removal of trichobezoar and the prevention of recurrences with psychotherapy.  Management options include endoscopic, laparoscopic or surgical removal by laparotomy .  Gorter et al* in a retrospective review of 108 cases of trichbezoar, evaluated the available management options:  5 % of Endoscopic attempts for removal were successful  75 % of Laparascopic attempts were successful  However, laparotomy was 100% successful and thus is the management of choice.  *Management of trichobezoar: case report and literature review R R Gorter 1, C M F Kneepkens, E C J L Mattens, D C Aronson, H A Heij Pediatr Surg Inter. 2010 May;26(5):457-63 A CASE OF TRICHOBEZOAR IN A TEENAGE GIRL 12
  • 13. “ ” Thank You THE THIRD SCIENTIFIC CONFERENCE OF AHH, 23RD OF FEBRUARY 2023 A CASE OF TRICHOBEZOAR IN A TEENAGE GIRL Dr. Mohammed Sultan ROD Surgery Dr. Mohamad Al-Gailani Consultant Surgeon
  • 14. ‫ا‬ ‫الكيالني‬ ‫محمد‬ ‫لدكتور‬ ‫الجراحة‬ ‫قسم‬ ‫رئيس‬ ‫الحمادي‬ ‫مستشفى‬ ‫الرياض‬ ‫السعودية‬ ‫العربية‬ ‫المملكة‬ 14