A case report of trichobezoar leading to intestinal obstruction in a young adolescent female

INTRODUCTION: Bezoars are concretions containing human and vegetable fibers accumulating in the gastrointestinal tract either in presence of altered gastric anatomy/physiology or continued ingestion of the indigestible offending substance. In humans, trichobezoar (hair) is the most common type amongst others like phytobezoars, lactobezoars and others made of indigestible material. Trichobezoars specifically, are not associated with alterations in gastrointestinal motility but with underlying psychiatric disorders, and commonly present in adolescent females. In a thorough literature search, we found that there were only a handful cases of trichobezoars, reported by Indian psychiatrists. CASE DESCRIPTION: A case of a 13 year old adolescent female with history of seizure disorder, presented to Emergency with symptoms suggestive of intestinal obstruction including poorly localized acute pain abdomen, non bilious postprandial emesis, and constipation. She was an underweight child with examination findings revealing hard, tender, non ballotable lump in epigastric region, exaggerated bowel sounds and patchy alopecia. X-ray and CT findings confirmed presence of a gastric trichobezoar extending into duodenum, removed by gastrostomy performed the day after. In the ensuing days, psychiatric evaluation revealed history suggestive of intellectual disability and frequent hair pulling behaviour. Patient was evaluated for various syndromal axis 1 disorders, and conscious effort to rule out obsession & impulse related disorders were made. She was discharged on low dose antipsychotics and asked to follow up with IQ assessment reports. DISCUSSION: Trichobezoar, an under diagnosed entity is commonly associated with psychiatric disorders like trichotillomania, trichophagia, mood disorders, history of neglect & mental retardation which we need to look out for.Materials and Methods: