Trichobezoar--a condition to think of in case of mobile abdominal mass

A twenty year old girl was referred to the surgical out-patients clinic with a history of intermittent epigastric pain and vomiting of five months duration. The patient enjoyed good health prior to this and her past medical history was uneventful. Findings on physical examination included pallor, patchy alopecia and a soft mobile, non-tender mass in the epigastrium and left upper quadrant of the abdomen. When questioned she admitted to a history of trichophagia for as long as she could recall. A provisional diagnosis of gastric trichobezoar was made. Radiological investigations included an abdominal ultrasound which showed a large ill-defined mass lesion with poor transonic features, situated in the upper abdomen and extending from the left upper quadrant across the midline to the liver margin. Barium meal revealed that the greater part of the lumen of stomach was occupied with material of an indeterminate nature. Her haematological investigations showed Haemoglobin 9.5 gm/dl and Leucocyte Count 9.0 x 10(9)/L. Her Urea and Electrolytes were within normal range. At laparotomy a large hair ball extending from the Stomach into the duodenum and proximal jejunum was removed through a vertical gastrotomy incision. The patient had a satisfactory post-operative convalescence and was discharged two weeks later.