A Case of Intestinal Obstruction with Trichobezoar

Yoshinobu Ichiki, Mitsuo Miyazawa, Yuya Takeuchi, Takashi Matsui, Atsushi Shimada, Takashi Ohishi, Hiroshi Isobe, Atsushi Kubochi, Toshiyuki Ikeuchi and Shingo Shima

Department of Surgery, National Tokyo Medical Center

Trichobezoar is a concentration of hair found in the stomach and intestine, Our case involved a trichobezoar causing ileus in a 15-year-old girl whose reported epigastralgia and vomiting in April 1997. Physical examination revealed a large, firm, nontender, mobile mass in the upper abdomen. Gastrointestinal endoscopy revealed a giant trichobezoar in the stomach too large to be extracted by endoscopy. Surgery was thought necessary to extirpate it, but the patient elected to delay surgery until after high school entrance examinations. In April 1998, she again reported epigastralgia and vomiting, Physical examination revealed the distended abdomen and the same mass in the upper abdomen. Abdominal radiography demonstrated intestinal dilatation and a prominent gastric outline. Though an ileustube was inserted, symptoms did not improved, necessitating surgery. Laparotomy revealed two intraluminal masses. A large trichobezoar was found in the stomach and another in the ileum about 120 cm from the ileocecal junction. One weighted 530 g and the other 70 g. The trichobezoar in the ileum apparently caused ileus. The postoperative course was uneventful. Psychiatric consultation prior to discharge revealed a background of trichotillomania. To prevent recurrence, the girl and her parents underwent psychological reorientation after surgery, with no recurrence of trichophagia.

Key words
Trichobezoar, ileus

Reprint requests
Yoshinobu Ichiki Second Department of Surgery, University of Occupational Environmental Health 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-0804 JAPAN

Accepted
November 29, 2000

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