By Dr. Sanjeevanee Kelkar

She is a general surgeon & for last 16 years has been working as a full time General Surgeon in a Charitable Trust Hospital in Nagpur. She is also a Senior Consultant & has been the Medical Superintendent also for last 5 years. 

• Trichobezoar extending from Stomach till terminal Ileum.• “Trichotillomania”• Trichobezoar is a rare clinical condition.• Stomach is the common site of occurance.• Intestinal obstruction due to trichobezoar is extremely rare.• Tricho=hair ,Bezoar=mass or ball.• Adolescent girls - 90% • H/O swallowing hair,,eating hair is found in 1:2000 children.• 10% patients show psychiatric abnormalities or mental retardation.• First case of human trichobezoar was reported by Baudamant in1779.

Problem-Stomach not able to exteriorize hair & other substances out of lumen because the friction surface is not sufficient for propulsion by peristalsis.

Indigestible matter trapped by mucus in stomach, forms shape of stomach gradually .

Age occurance----1year to 56 years Common age---15 to 20 years & 90%

girls Symptoms—Epigastric

pain,dyspepsia,postprandial fullness. Gastric bleeding—6%. Intestinal obstruction or perforation—

10% Iron def.anemia.

Investigations

Proper history=suspicion.only Xray,only barium meal if done. Usg-high echogenicity of hair &

presence of multiple acoustic interfaces created by trapped hair & food limits usg diagnosis.

Endoscopy. CT & MRI.

Ms. Poojabai Patel.(from Damoh M.P.) 14 year old girl was admitted in CIIMS on 20th July

evening with acute colicky abdominal pain of 25 days duration.

She was persistently vomiting and was restless for 7 days.

Her vitals were B.P.110/70mmhg,pulse 110/mt,pale dehydrated .

Her xray standing abdomen revealed subacute intestinal obstruction.

She was managed conservatively,R.T,I/V fluids Enemas, Duphalac ,responded by passing motion, reduction in distention ,hence conservative management was continued. On 3rd day she was again the same ,hence decided to be taken for exploratory laparotomy.

Laparotomy –grossly distended small bowel loops with multiple perforations ,adhesions ,intussusception—causing intestinal obstruction.

grossly dilated terminal ileum,in which some funny cordlike thing was felt.

perforations revealed trichobezoar.Evacuated.

Laparotomy –grossly distended small bowel loops with multiple perforations ,adhesions ,intussusception—causing intestinal obstruction.

grossly dilated terminal ileum,in which some funny cordlike thing was felt.

perforations revealed trichobezoar. Evacuated.

Multiple mesenteric Lymph nodes enlarged.

Resection & anastomosis was done. Stomach was inspected & found huge

bezoar. Gastrotomy done and huge stomach –

shaped trchobezoar evacuated. Lavage, hemostasis,drainage & closure.

Postoperatively first 48 hours was o.k./, then bp started fluctuating ,shifted to ICU,INR deranged,

In spite of doing everything died after 72 hours, the pathetic ending .