A rare case of tricho bezoar presenting as pain abdomen to the emergency

A trichobezoar is a mass of undigested hair within the gastrointestinal tract. Trichobezoars are often associated with trichotillomania (hair pulling), and trichophagia (hair swallowing). Trichotillomania may be unconsciously or unintentionally done and is part of the DSM IV psychiatric classification of impulse control disorders ( Gastrointestinal Bezoars, 1991; Trichobezoar, 1972). In up to 18% of patients with trichotillomania, trichophagia occurs; one third of patients with trichophagia develop trichobezoars (Sood, 2000). Trichobezoars most commonly occur in adolescent females ( Lamerton, 1984). The site of hair pulling is most commonly from the scalp, but can occur from the eyelashes, eyebrows, and pubic area ( Taylor, 1975). Trichobezoars commonly occur in adolescent females, often with an underlying psychiatric or social problem. Clinical presentation of these patients may be confusing as often they are not forthcoming with a history of trichophagia either due to embarrassment or the unintentional nature of the problem. Although this is a rare condition, numerous case reports and series have been reported as high mortality may follow complications associated with this condition. Trichobezoars in humans were first described from a post mortem by Swain in 1854 (Ratcliffe, 1982). The postulated reason for formation in the stomach is that hair is undigestable and due to its smooth nature cannot be propulsed with peristalsis and over time forms a bezoar within the stomach. Presentation ranges from nonspecific abdominal or epigastric pain, to a range of complications as mentioned. In 5% patients diagnosed with Trichobezoars , attempted endoscopic removals were successful and in 75% of patients attempted laparoscopies were successful. However, laparotomy was 100% successful and thus favoured as their management of choice.