Trichobezoar in a 11-year old girl: a case report

Bezoars are masses of solidified organic or nonbiological material commonly found in the stomach and small bowel. Identification, therapy, and long-term management of patients with bezoars depends on accurate classification and knowledge on the pathophysiology of formation. Four types of bezoars have been described based on their composition: phytobezoars, trichobezoars, lactobezoars, and miscellaneous. Pediatric trichobezoars are associated to emotional disturbed children with aberrant appetite (trichophagia). Hair strands become retained and attached in the folds of the gastric mucosa because the friction surface is insufficient for propulsion by peristalsis. They generally are asymptomatic until enlargement produce pain, compression or intestinal obstruction. Bezoars are diagnosed with conventional radiology and gastroscopy permits identification of its nature. Currently, management of bezoars consists of: dissolution, suction, lavage, mechanical endoscopic fragmentation using pulsating jet of water, fragmentation with extracorporeal shock wave lithotripsy and surgical removal. Treatment should also focus on prevention of recurrence, since elimination of the mass will not alter the conditions contributing to their formation.