2022, Number 2
Management of trichobezoar: case report
Velázquez BG, Victoria SD
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Language: Spanish
References: 12
Page: 51-61
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Introduction. A bezoar is a collection of foreign material in the digestive tract. Trichobezoar is the most common variant (50% of cases). They occur predominantly in the female sex (90%) the majority in those under 30 years, most commonly occurring between the ages of 10 and 20. They are of variable size, depending on the rate of occurrence of trichophagia, time of evolution and the length and quantity of ingested hair. Clinical presentation often presents the classic triad: abdominal pain (37%), weight loss (38%) and palpable abdominal mass, predominantly epigastric (70%). Trichobezoars are resistant to enzymatic dissolution and therefore require endoscopic or surgical management. They are also associated with mental illnesses such as anxiety disorders, obsessive-compulsive disorder, and intellectual disability.This surgical finding is rarely reported. In Mexico, four clinical cases have been described, two of them in Mexico City, one in Culiacán and the last one in Veracruz.
Case. A 17-year-old female patient with a psychiatric history of an anxiety symptoms that has developed into an impulse control disease of trichotillomania and trichophagia. She received medical attention at a third level of care institution by the surgery service where surgical extraction was performed. Subsequently, a psychiatric evaluation was requested to complement therapeutic management protocol.
Discussion. The report of this case allows us to define the cause of trichotillomania and trichophagia; it also helps us understand the psycho-emotional context that surrounds the patient and the internal stressors that trigger impulsivity. It is the second reported and the first with comprehensive intervention in the state of Veracruz.
Conclusion. The therapeutic management of a trichobezoar does not end with surgical removal; it is necessary to complement clinical approach with psychiatric assessment that defines the aetiology of trichotillomania and whether there is any comorbidity.
Recommendations: Prepare a complete clinical history, including psychiatric history, and perform a detailed physical examination. Collaborate with other clinical specialties that are necessary to integrate an adequate diagnosis and treatment.
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