Trichobezoer: An Unusual Presentation with Congestive Heart Failure

Description Trichobezoars are impactions of hair that accumulate in the gastrointestinal track and are most often located in the stomach. They are often associated with psychiatric illnesses like trichotillomania and trichophagia, which usually occurs in young and adolescent females. Gastric trichobezoars (GT) are the most common variety of bezoar found in the stomach. The most common complications that arise alongside GT include gastric erosion, ulceration or perforation of the small intestine. Gastric outlet obstruction, obstructive jaundice, pancreatitis and death have been reported, though these complications are rare. We report a 40-year-old female who presented to the hospital with dyspnea on exertion and ankle swellings. She also reported abdominal distension, a 40 pound weight loss, nausea and vomiting. Her examination was remarkable for sinus tachycardia, displaced apex beat and a split second sound. She was suspected of congestive heart failure. Upper endoscopy revealed a large trichobezoar in the antrum and the body of the stomach. She was found to be markedly anemic and in hypothyroid state. She underwent surgical removal of the GT subsequent to stabilization of heart failure. She later admitted to psychiatry a history of hair pulling and swallowing under stressful conditions.