S. Jidane^1*, K. Belgassi², A. Belkouch, S. Zidouh, L. Belyamani

¹Emergency Department, Mohammed V Military Hospital of Instruction, Mohamed V University of Rabat, Morocco

²Anesthesiologist at El Gharb Private Clinic, Kenitra, Morocco

*Corresponding Author: S. Jidane, Emergency Department, Mohammed V Military Hospital of Instruction, Mohamed V University of Rabat, Morocco.

Introduction
Hair pulling (trichotillomania) and hair eating (trichophagia) are the most common causes of trichobezoar conditions. Because of its smooth surface, human hair is resistant to digestion and peristalsis and can become trapped in the lumen. As a result, hair collects in the mucosal folds of the stomach. The swallowing of hair, mucous, and food continuously can cause impaction, creating a trichobezoar [1].

Keywords: Trichobezoar - School-aged girl - Gastric - Abdominal mass

Case observation
We report a case of a 15-year-old girl who presented initially to a private clinic at Kenitra City in the north-west of Morocco, brought by her family for an epigastric mass accidentally discovered by her mother, with a history of decreased appetite, weight loss, and transit disorder during the last few months. At her examination, the girl was asthenic and pale. Abdominal palpation revealed a hardened, well-defined mass measuring about 24 x 12 cm, non-painful. The rest of the physical examination was regular.

Given her father's work, the girl was transferred to the Military Hospital in Rabat, where an abdominal computed tomography found a heterogeneous dense mass occupying the whole stomach up to the pylorus (Figure 1). The biological assessment performed did not show any disorders except the hypochromic microcytic anemia at 10 g.dl-1, with no signs of infection or organ failure. No electrical abnormalities founded in her EKG.

Figure 1: post-operative large trichobezoar measured 26.6 x 13.2 cm, with a long tail of hair.

Subsequently, surgical intervention was planned through a midline laparotomy with gastrotomy on the anterior portion of the gastric body. A large trichobezoar was discovered within the stomach with a putrefied smell, extending from the fundus to the proximal duodenum, and was successfully removed in one piece. It measured 26.6 x 13.2 cm, with a long tail of hair witch length was 21 cm (Figure 2).

Figure 2: abdominal computed tomography showed an heterogeneous dense mass occupying the whole stomach up to the pylorus

During the postoperative recovery phase, the patient and her family were questioned about the cause of the trichobezoar. The mother reported involuntary nocturnal trichotillomania, but no notion of trichophagia was evoked. She said she forbade her from doing that again without any oversight or psychological follow-up. The patient associated this behavior with school repression by her classmates and teachers since childhood.

The postoperative follow-up was uneventful, and the patient was discharged from the hospital on the seventh day after surgery and referred to the psychiatrist for psychological support. Follow-up for a medical control at six months was satisfactory and showed a marked improvement in weight, mental health, and in her school relationships.

Patient consent: This report does not contain any personal information that could lead to the identification of the patient.

Funding: No funding declared.

Conflict of interest: No conflict of interest was declared.

References

1. Ahmed MM, Tahir KS, Gubari MIM, Rasul RHK, Rashid MJ, et al. (2021) Large trichobezoar associated with misdiagnosis, a rare case report with a brief literature review. International Journal of Surgery Case Reports. 88: 106551.
2. López-Álvarez LM, Moreno-Castellanos MA, Álvarez-Acuña AM, Echeverri-Mejía C, Narvaez-Rojas A, et al. (2022) Huge gastric trichobezoar caused by involuntary nocturnal trichophagia and trichotillomania in a female adolescent. International Journal of Surgery Case Reports. 99: 107627.