Trichobezoar-induced intestinal obstruction-complete bowel obstruction in a young female with underlying psychiatric...

A bezoar is a mass of undigested or partially digested material in the gastrointestinal tract, with trichobezoar being the second most common type. It is primarily composed of hair and can lead to complications such as bowel obstruction, ulceration, perforation, and intussusception. Early diagnosis is challenging due to vague symptoms, making it critical to have a high index of suspicion. The inclusion of sanitary pad within the trichobezoar makes this case unique.

A 26-year-old Ugandan female presented with features of complete bowel obstruction. Contrast Enhanced Computed tomography (CECT) of the abdomen and pelvis revealed foreign bodies in the small intestine, necessitating an exploratory laparotomy. Two large trichobezoars, measuring 8 cm × 15 cm and 6 cm × 10 cm, were successfully retrieved via enterotomy. A retrospective evaluation revealed underlying psychiatric disorders, leading to the diagnosis of depression and adjustment disorder. Postoperatively, the patient recovered uneventfully and was discharged with advice for psychiatric follow-up.

Trichobezoar is commonly seen in young females, often associated with psychiatric conditions (trichotillomania and trichophagia) in 10 % of cases. Bowel obstruction remains the most typical presentation, and CECT of the abdomen and pelvis is crucial for diagnostic confirmation. Laparotomy remains the preferred surgical treatment, and psychiatric consultation is crucial for long-term management and preventing recurrence.

Trichobezoar is a rare yet serious condition that requires early diagnosis and intervention. In cases presenting with acute bowel obstruction, subtle findings such as short or thinning scalp hair may provide a clue to the diagnosis.