Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 16, 2015; 3(5): 466-469
Published online May 16, 2015. doi: 10.12998/wjcc.v3.i5.466
Extremely unusual case of gastrointestinal trichobezoar
Sopan N Jatal, Nawab P Jamadar, Bhagwat Jadhav, Saleha Siddiqui, Sachin B Ingle
Sopan N Jatal, Jatal Hospital and Research Centre Latur, Maharashtra 4132512, India
Nawab P Jamadar, Bhagwat Jadhav, Department of Anesthesia, MIMSR Medical College, Latur, Maharashtra 4132512, India
Saleha Siddiqui, Department of Pathology, MIMSR Medical College, Latur, Maharashtra 4132512, India
Sachin B Ingle, Department of Pathology and Secretary Research and Development, MIMSR Medical College, Latur, Maharashtra 4132512, India
Author contributions: Siddiqui S and Ingle SB prepared the manuscript; Jatal SN, Jamadar NP and Jadhav B critically revised the intellectual content and gave final approval of manuscript.
Conflict-of-interest: None to be declared.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sachin B Ingle, Professor, Department of Pathology and Secretary Research and Development, MIMSR Medical College, Ambajogai Road, Latur, Maharashtra 41353, India. dr.sachiningle@gmail.com
Telephone: +91-2382-227424 Fax: +91-2382-228939
Received: December 17, 2014
Peer-review started: December 18, 2014
First decision: December 26, 2014
Revised: January 29, 2015
Accepted: February 9, 2015
Article in press: February 11, 2015
Published online: May 16, 2015
Abstract

Trichobezoars (hair ball) are usually located in the stomach, but may extend through the pylorus into the duodenum and small bowel (Rapunzel syndrome). Rapunzel syndrome remains uncommon; with fewer than 40 cases reported. To the best of our knowledge, this case may be the first well-documented case with a length of 75 cm. They are almost always associated with trichotillomania and trichophagia or other psychiatric disorders. In the literature several treatment options are proposed, including removal by conventional laparotomy, laparoscopy and endoscopy. Herein, we are reporting an interesting case of an 18-year mentally retarded girl with history of trichotillomania and trichophagia who presented to our emergency department with a history of central abdominal pain associated with vomiting and constipation for five days. An examination showed a trichobezoar requiring emergent surgical intervention, and indicating the need for psychiatric treatment. The trichobezoar was treated successfully by laparoscopy.

Keywords: Giant Trichobezoar, Therapy Endoscopy, Trichotillomania, Rapunzel syndrome, Laparoscopy

Core tip: Laparoscopic management is ideal for trichobezoar due to an improved cosmetic appearance, fewer postoperative complications, and reduced hospital stay. It has a better outcome with many benefits over laparotomy and is slowly becoming the treatment of choice. After trichobezoar removal, prognosis is good if psychiatric therapy to control habitual trichophagia is successful.