Fecha de publicación: 24 Febrero 2011
Departamento de Aparato Digestivo. Complejo Hospitalario Torrecárdenas, Almería.
17 year old woman with a history of trichotillomania and trichophagia with a previous episode of gastric trichobezoar that required surgical excision with wide gastrostomy at the age of 9. Subsequently, the patient did not follow examinations due to her Mental Health.
She was currently admitted into hospital for a picture of nausea and vomiting of food content associated with early satiety, epigastric discomfort and weight loss. No other symptoms were observed and trichophagia was negative.
On examination she showed a good general condition, hemodynamically stable, a normal color of the skin and mucous membranes.
There were focal areas of alopecia on the head. Abdomen: laparotomy incision scar post laparotomy. On palpation a hard consistency, painless mass with no signs of peritoneal irritation could be noticed in the epigastrium. The rest of the examination was unremarkable.
In additional tests, the results were normal. The standing radiograph of the abdomen showed dilatation of the gastric chamber which was almost entirely occupied by an opaque cylindrical radio image compatible with a foreign body. In an upper endoscopy a large hard foreign body covered with hair could be identified occupying the gastric cavity without allowing its fragmentation or even the passage of the endoscope into the duodenum.
She was diagnosed with the Rapuntzel Syndrome: trichobezoar that stretched from cardia to second duodenal portion. The patient received psychiatric treatment for the trichotillomania disorder and was referred to the surgery unit, where they could finally extract a 25 x 8 cm trichobezoar which extended to the second duodenal portion by midline laparotomy and subsequent gastrostomy. Postoperative was favorable. Nowadays the patient is following examinations carried out by the Mental Health and Gastroenterology Services.
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