Trichobezoar, trichophagia and trichotillomania

Abstract

Introduction: Trichobezoar, tricophagia or Rapunzel Syndrome is an extremely rare psychiatric and intestinal condition in humans, resulting from eating hair. It is Associated with the hair pulling disorder Trichotillomania. The peak age of onset is 9 to 13 but it has been also found in infants. Objective: Describe the case of a patient with trichobezoar, tricophagia and trichotillomania that underwent laparotomy. Clinical case: We present 9-year-old patient admitted to the Gastroenterology department in Miercurea Ciuc, Romania with 5 months history of abdominal pain and repeated vomiting. Abdominal ultrasonography revealed an intra-gastric foreign body. After 6 months, the patient was hospitalized in our department of Orthopedics and Pediatric Surgery in Targu Mures with the same complaints. On physical evaluation, the abdominal examination revealed a well defined and firm mass in the left upper abdominal quadrant. Transaminases were slightly elevated and hair was found on fecal culture examination. All other examinations were normal. The patient was referred to a psychiatry examination and came back with the following diagnosis: trichotillomania, Pica eating disorder and obsessive compulsive disorder. An abdominal radiograph confirmed the intra-gastric foreign body which continued in the pylorus and duodenum. Upper gastrointestinal endoscopy highlighted a large trichobezoar and surgical treatment was recommended. We performed a mid-line laparotomy followed by a gastrostomy and removal of the hair mass.Results: There were no complications whatsoever, no signs of perforation, and the postoperative wound was clean. There was no pain in the epigastric region following surgical treatment and the mass was completely removed. The patient status was stable and she was discharged two weeks after the surgery. Further psychiatric treatment was recommended to avoid recurrence. Conclusions: Conventional radiology and upper gastrointestinal endoscopy proved to be the best methods of investigation in this case. Recurrence of tichobezoar can occur if the latent neuro-psychiatric disorder is not correctly treated using a multi-disciplinary team.