Gastric ulceration and perforation secondary to large trichobezoar – A case report describing the role of magnetic resonance imaging in diagnosis. (2018)

• Record Type: Journal Article
• Authors: Hennessy, M.M.; Ivanovski, I.; Ó Súilleabháin, C.B.
• Is Part Of: International journal of surgery case reports. Volume 43(2018)
• Page Start: 25
• Page End: 28
• Publication Date: 2018
• Subjects: Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2018.01.004
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Trichobezoar is frequently dismissed in the differential diagnosis of young female patients with a history of trichophagia and trichotillomania, chronic abdominal pain, nausea, and vomiting. MRE is useful, particularly in young people who must not be exposed to unnecessary CT radiation. Esophagoduodenogastroscopy is also helpful. Management options for the treatment of the trichobezoar include surgical removal by laparotomy or laparoscopically, while laparotomy is widely considered as the treatment of choice for complicated trichobezoars. Psychiatric review post operatively must be completed to reduce recurrence. Abstract: Introduction: Trichotillomania and trichotillophagia can result in huge intraluminal coagulations of hair. Rarely, these can present with gastric perforation. This work has been reported in line with the SCARE criteria (Agha et al., 2016) [1 ]. Presentation of case: We report the case of a 15 year old girl who attended the emergency department with abdominal pain and vomiting. Ultrasound abdomen and pelvis identified free fluid within the pelvis concerning for inflammatory bowel disease. A subsequent magnetic resonance enterography (MRE) demonstrated a giant gastric trichobezoar which resulted in gastric perforation necessitating laparotomy and gastrotomy. The patient recovered well from the surgery and was reviewed by the psychiatry service prior to discharge. Discussion: Trichobezoar is a challenging diagnosis and as clinician, we must always include it in our differential diagnosis. The clinical presentation, signs and symptoms depend on the size of the trichobezoar and the presence of complications. Management is almost always surgical. Conclusion: This case illustrates the infrequent perforation risk of gastric bezoars and the important role of magnetic resonance imaging in diagnosis, particularly in a population who must not be exposed to excessive radiation.