Gastrointestinal trichobezoar: An experience with 17 cases

Background: Trichobezoar is an exceedingly rare entity in children and mimics other chronic ailments such as abdominal tuberculosis or malignancy. Delayed diagnosis and management result in various complications. The study was conducted to describe our experience with 17 consecutive cases of gastrointestinal tract (GIT) trichobezoars.

Materials and methods: We reviewed medical records of 17 consecutive cases of GIT trichobezoar managed in our department between January 2005 and December 2018.

Results: There were 3 males and 14 females. The median age of presentation was 7 years. Fifteen patients (88%) presented with abdominal pain and vomiting, while 8 (47%) had abdominal distension. Seven (41%) patients developed complications secondary to the GIT trichobezoar (intussusception and gangrene in 1, small bowel obstruction in 4, gastric perforation and massive bleeding per rectum in 1, acute transient pancreatitis and hypertension in 1). At operation, 9 (54%) patients had Rapunzel syndrome, 6 (35%) had gastric trichobezoar, and 2 (12%) had small bowel trichobezoars. One patient presented with massive bleeding per rectum and gastric perforation, succumbed postoperatively. One patient developed a recurrent trichobezoar.

Conclusion: GIT trichobezoar is rare in children and simulates chronic gastrointestinal ailments. Trichobezoars may reside in the alimentary tract, remain unnoticed for years, and become overt with the onset of complications. The majority of trichobezoars had a tail in our series. Life threatening complications can occur with delayed presentations.

Type of study: Case series.

Level of evidence: Level IV.

Keywords: Acute abdomen; Foreign body ingestion; Rapunzel syndrome; Trichobezoar; Trichophagia; Trichotillomania.