MyPACS.net: Radiology Teaching Files > Case 2319314

previously visited TRICHOBEZOAR IN STOMACH AND DUODENUM
Contributed by: Dr Phillip Silberberg, Children's Hospital Omaha, Radiologist, Omaha Childrens, Creighton University and UNMC, Nebraska, USA.
History: Referred for CT for suspected gastric mass
Images:[small]larger

Fig. 1: CT. Trichobezoar in stomach and duodenum. Note whorled foreign body in stomach and proximal duodenum.

Fig. 2: CT. Trichobezoar in stomach
Diagnosis: Trichobezoar in stomach and duodenum
Discussion: Introduction

Trichobezoars are hair casts which are usually found in the stomach or small intestines, and are typically caused by ingestion of hair.  Many cases of trichobezoars occur in patients with the anxiety disorder trichotillomania, in which the patient's anxiety manifests itself with pulling of their own hair.  This can lead to noticable alopecia.

Presentation

Eighty percent of trichobezoars occur in patients less than 30 years old, and 90% of the patients are female.  Intially, trichobezoars typically present with anorexia, weight loss, occasional headaches and sometimes vague abdominal pain.  As the trichobezoar grows in size it may present as a firm epigastric mass and can result in anemia likely due to impaired absorption and geastric function, abdominal pain, hematemesis, nausea and/or vomiting due to partial obstruction, or total bowel obstruction.  GI perforation and gastrointestinal (GI) bleeding can occur as the trichobezoar erodes through the GI tract.  Acute pancreatitis, and obstructive jaundice may also occur if the trichobezoar obstructs the ampulla in the duodenum.

Diagnostic imaging

Ultrsound will reveal a echogenic banding pattern caused by hair and food debris which becomes trapped within the mass.  CT typically reveals a low-attenuated mass which frequently will have air trapped within the mass.  CT may also show signs of perforation, abscess, or obstruction.  MRI results will be variable due to the heterogeneous content of the mass containing air, fluid and foreign bodies.

Treatment

Treament of trichobezoars is removal.  This can be done either endoscopically or by laparoscopic surgery or open surgery.  CT-guided drainage of accompanying abscess with placement of temporary drain may also be required.  The bezoar is often very foul smelling.

References: References:

Koplewitz, BZ, et al.  "Case 29: Gastric bezoar and subphrenic abscess."  Radiology
(2000) 217:739-742

McCracken S, Jongeward R, Silver TM, Jafri SZH.  "Gastric trichobezoar: Sonographic findings"  Radiology.  (1986) 161: 123-4

Contributed by:

Corey Zetterman, Medical Student, Creighton University Medical Center, Omaha, NE

Dr. Phillip Silberberg, Omaha Children's Hospital, Creighton University and UNMC, Omaha, NE
Comments:
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Additional Details:

Case Number: 2319314Last Updated: 05-02-2007
Anatomy: Gastrointestinal (GI)   Pathology: Benign Mass, Cyst
Modality: CTAccess Level: Readable by all users

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