University of Texas Medical Branch at Galveston Galveston, TX, United States
Barbara Mensah, BS1, Jaison S. John, MD1, William M. Tung, MD1, Kevin Kline, MD2, Minh N. Tran, MD1, Michael J. Antony, MD2, Sreeram Parupudi, MD1 1University of Texas Medical Branch at Galveston, Galveston, TX; 2University of Texas Medical Branch, Galveston, TX
Introduction: Trichobezoars are an unusual condition that occurs when human hair accumulates in the gastrointestinal tract, resulting in hair impaction mixed with food and mucus. Rarely hair strands from a gastric trichobezoar can extend through the pylorus into the small bowel, resulting in a condition known as Rapunzel syndrome. Serious complications can occur including pancreatitis, protein-losing enteropathy, intussusception, ulceration, perforation, and death. Although uncommon, this case highlights the importance of having a clinical suspicion and demonstrates the difficulties encountered with endoscopic removal.
Case Description/Methods: A 23-year-old woman with a history of prior trichobezoar as a teenager resulting in surgical removal presented with epigastric abdominal pain, early satiety, vomiting and diarrhea. Patient reported ingestion of hair for 8-9 months with last episode of trichophagia three weeks prior. On exam, the patient’s hair on scalp was noted to be at varying stages of growth, and abdomen was distended with mild epigastric tenderness. CT abdomen revealed large volume ingested material in stomach and proximal small bowel, with distention from proximal small bowel to ileum. Upper endoscopy confirmed the presence of a trichobezoar in the gastric fundus and lesser curvature of gastric body with a long and thin strand of hair extending through the pylorus. Attempts at endoscopic removal via use of snare device and argon plasma coagulation were unsuccessful. Patient underwent successful removal of trichobezoar through surgical anterior gastrotomy and was discharged uneventfully.
Discussion: A trichobezoar is a rare complication that involves accumulation of ingested human hair in the GI tract and can take months to years to develop. Patients can present with obstructive symptoms including abdominal pain, distention, nausea, vomiting, diarrhea, constipation and decreased appetite. Trichobezoars can go undiagnosed without clinical suspicion and in those cases, patients are diagnosed intra-operatively. Although rare gastroenterologists should be aware of clinical presentation and management of trichobezoars. CT imaging can aid in diagnosis, and there should be a low threshold for endoscopy for diagnostic and potentially therapeutic benefit. Endoscopic fragmentation and removal of trichobezoars is of varying success and carries the risk of esophagitis, esophageal perforation, and formation of pressure ulcers from repeated passage of endoscope. Surgical management is definitive for removal.
Figure: Figure 1. A) Trichobezoar noted in gastric body. B) Thin strand of hair extending through pylorus. C) Retroflexion view. D) Attempt at fragmentation with argon plasma coagulation. E) CT imaging demonstrating trichobezoar in stomach. F) Trichobezoar after surgical removal.
Disclosures: Barbara Mensah indicated no relevant financial relationships. Jaison John indicated no relevant financial relationships. William Tung indicated no relevant financial relationships. Kevin Kline indicated no relevant financial relationships. Minh Tran indicated no relevant financial relationships. Michael Antony indicated no relevant financial relationships. Sreeram Parupudi indicated no relevant financial relationships.
Barbara Mensah, BS1, Jaison S. John, MD1, William M. Tung, MD1, Kevin Kline, MD2, Minh N. Tran, MD1, Michael J. Antony, MD2, Sreeram Parupudi, MD1. P1501 - A Hairy Situation: Recurrent Trichobezoar in a Patient Presenting With Abdominal Pain and Emesis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.