Tracheobronchial and oesophageal foreign bodies
Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven in Succeeding in Paediatric Surgery Examinations, 2017
Trichobezoar, a hairball in the proximal gastrointestinal tract, is a rare condition almost exclusively seen in young females with psychiatric illness. Human hair is resistant to digestion as well as peristalsis because of its smooth surface. Therefore it accumulates between the mucosal folds of the stomach. Continuous ingestion of hair leads to the accretion of hair, mucus and food, and results in the formation of a trichobezoar. In most cases, the trichobezoar is confined to the stomach. Medical treatment and enzymatic degradation, although attractive because of their non-invasiveness, are ineffective. While endoscopic removal would also be an attractive option, reports of successful endoscopic removal of trichobezoars are remarkably scarce and are vastly outnumbered by case reports documenting unsuccessful attempts of endoscopic removal with or without fragmentation in children. Laparoscopy may be a reasonable option, but the gold standard at this time remains a laparotomy with gastrotomy and removal of the mass. A recent review (Gorter 2010, et al.) demonstrates a 5% success rate for endoscopy, a 75% rate with laparoscopy, and a 99% success rate with a laparotomy.
Stomach and duodenum
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
Trichobezoar (hair balls) (Figure63.34) are unusual and are virtually exclusively found in female psychiatric patients, often young. It is caused by the pathological ingestion of hair, which remains undigested in the stomach. The hair ball can lead to ulceration and gastrointestinal bleeding, perforation or obstruction. The diagnosis is made easily at endoscopy or, indeed, from a plain radiograph. Treatment consists of removal of the bezoar, which may require open surgical treatment. Phytobezoars are made of vegetable matter and found principally in patients who have gastric stasis. Often this follows gastric surgery.
Psychocutaneous Disorders
Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang in Roxburgh's Common Skin Diseases, 2022
Hairs are sometimes ingested causing a mass within the intestines which is referred to as a trichobezoar. In severe cases, trichobezoars may obstruct the intestines and cause associated gastrointestinal symptoms that may be apparent on evaluation.
Review of epidemiology, clinical presentation, diagnosis, and treatment of common primary psychiatric causes of cutaneous disease
Published in Journal of Dermatological Treatment, 2018
J. A. Krooks, A. G. Weatherall, P. J. Holland
Patients with TTM recurrently pull out their hair, resulting in prominent hair loss and significant distress and/or functional impairment (95). The median time spent engaging in behavior is 45 min/day (range 15–240 min) (96). Patients predominantly pull hair from the scalp (83%) (97). Other regions implicated include eyelashes, eyebrows, and pubic, face, and body hair (98). Trichophagia (swallowing hair after pulling it out) is observed in over 20% of patients and may result in a life-threatening trichobezoar (hairball) that may block the intestine and require emergency surgery (99). Patients may present with abdominal or chest pain, change in bowels, unexplained weight loss, and/or vomiting. Abdominal CT scan is diagnostic in 97% of cases (95). Typical age at onset is 10–13 years. There is a 4:1 adult women: male prevalence and an equal gender distribution in children (95). Prior studies have reported a prevalence of 0.6%; however, the prevalence is likely higher considering patients’ reluctance to reveal behavior and updated, less stringent diagnostic criteria (95).
Pharmacotherapy for trichotillomania in adults
Published in Expert Opinion on Pharmacotherapy, 2020
Christine Baczynski, Verinder Sharma
When left untreated, TTM can have a detrimental effect on an individual’s mental and physical wellbeing. A study by Stemberger et al. found that over 70% of the patients reported significant feelings of shame, irritability, and low self-esteem related to their hair pulling [35]. Over 80% of patients in the same study reported feeling depressed or unattractive because of their illness. Other studies have shown that patients report several impairments in the areas of social and occupational functioning, such as decreased quality of interpersonal relationships and interference with daily job duties [1,10,35]. Trichotillomania can also have negative physical consequences, such as inflammation of hair follicles and surrounding skin and complications that arise from trichophagia [31] (eating the hair that has been pulled) in some patients, such as gastrointestinal issues and development of a dangerous and potentially life-threatening blockage in the intestinal tract known as a trichobezoar [36].
Trichobezoar presenting as an acute abdominal obstruction in a 17-year-old girl
Published in Paediatrics and International Child Health, 2022
Zuhal Bayramoglu, Rana Gunoz Comert, Basak Erginel, Abdulkadir Baziki
Bezoar obstruction of the small intestine and giant bezoar in the stomach are rare causes of vomiting in adolescents and young adults and require surgical removal. Foreign bodies swallowed by pre-school-age children include toys, while adolescents may repeatedly ingest organic foreign bodies. Mental retardation or psychiatric disorders are usually the basis of these behavioural disorders [7]. Bezoars may require admission to hospital owing to non-specific findings such as an inability to gain weight, growth retardation, anaemia, vomiting and abdominal tenderness. In the presence of dyspeptic symptoms such as vomiting and regurgitation, if there is an enlarged stomach on imaging, bezoars in the gastric lumen should be considered; other causes include pyloric stenosis and superior mesenteric artery syndrome. Since bezoars are formed from indigestible food residue, they are of soft tissue density on radiography, but contrast with the air surrounding the bezoar in the enlarged intestinal lumen may provide a clue to the diagnosis [8]. Children with iron deficiency should be carefully evaluated as the deficiency may progress owing to mucosal irritation. Bezoars can also be caused by pica [9]. In this case, significant anaemia (<8 g/dL) did not develop, despite the large size of the trichobezoar.
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