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[Intestinal trichobezoar: differential diagnosis in children with an abdominal mass]
Insights
Intestinal trichobezoars are rare pediatric abdominal masses. This case highlights a 10-year-old girl with an intestinal obstruction misdiagnosed as lymphoma, emphasizing the need to consider trichobezoars in differential diagnoses.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Imaging
Background:
- Intestinal trichobezoars are rare gastric foreign bodies, often associated with psychiatric conditions, and rarely present as abdominal masses in children.
- Differential diagnosis of pediatric abdominal masses typically includes neoplasms, infections, and congenital anomalies, often overlooking rare entities like trichobezoars.
Observation:
- A 10-year-old girl presented with a five-month history of an inferior hemi-abdominal mass, progressing to severe illness with signs of intestinal obstruction within 24 hours.
- Initial diagnosis was non-Hodgkin lymphoma, but the clinical presentation also suggested Rapunzel syndrome, a rare variant of gastric trichobezoar extending into the small intestine.
Findings:
- Surgical intervention revealed a large intestinal trichobezoar as the cause of the obstruction, contrary to the initial suspected malignancy.
- The trichobezoar's significant size and location within the intestine led to acute intestinal obstruction, mimicking other intra-abdominal pathologies.
Implications:
- This case underscores the importance of including intestinal trichobezoars in the differential diagnosis of pediatric abdominal masses and intestinal obstructions, despite their rarity.
- Early recognition and diagnosis of intestinal trichobezoars can prevent delayed treatment and potentially severe complications such as obstruction and perforation.
Abstract:
Due to it's rare appearance, the intestinal trichobezoar is usually not considered as a differential diagnosis of abdominal masses seen in children. A case of a 10 year old girl with a five month evolved inferior hemi-abdominal mass is cited. The girl appeared severely ill and within 24 hours of her physical examination, showed signs and symptoms of an intestinal obstruction. She was admitted to surgery with the diagnosis of a non Hodgkin lymphoma. Due to its' presentation, we may have even supposed it to be a case of Rapunzel syndrome which grew within the intestine causing obstruction or which may have initially grown in the terminal ileum. The medical literature is reviewed.