Background: A bezoar is a collection of indigestible substances that, after swallowing, form a mass in the gastrointestinal tract, most often in the stomach. A trichobezoar is a mass made of ingested, undigested hairs and food remains, while ingestion of hair is called trichophagia. This is an extremely rare condition, with 90% of cases occurring among women, out of which 80% are under the age of 30. The diagnosis is based on clinical examination, findings obtained through radiological modalities (ultrasound and computed tomography) and endoscopy. Objective: The aim of this article is to present the case of a 17-year-old female patient who visited the doctor due to abdominal pain and a visible mass in the projection of the stomach. Case presentation: The patient, accompanied by her parents, and following the instructions of a general practitioner who suspected the presence of a tumour in the abdomen, reported to the surgical clinic. The US examination revealed the presence of a heteroechoic mass in the stomach area, but it could not be determined with certainty where it belonged (Samsung Medison V8 ultrasound system). The CT scans revealed the presence of an inhomogeneous structure in the stomach area occupying the entire volume of the stomach. The mentioned structure included the presence of internal air particles and marginal imbibition of the orally applied contrast agent. The described structure did not infiltrate the stomach wall and, based on the CT scan, the diagnosis established was a bezoar. Under general anaesthesia, a laparotomy with a gastrotomy was performed, and a hard hook shaped mass composed of hair and remains of undigested food was removed from the stomach. Conclusion: A mobile, palpable mass located in the abdomen of younger female patients accompanied by abdominal symptoms, especially in patients where there is information about hair pulling and swallowing, may suggest trichobezoar. The golden standard for trichobezoar presentation is upper endoscopy. If unavailable, the diagnosis is established by a CT scan, preferably with oral application of a contrast agent. Treatment of larger trichobezoars is surgical, while endoscopic and laparoscopic removal is possible only in the case of small trichobezoars.
Key words: Trichobezoar, computed tomography, laparotomy.
|
