Huge gastric trichobezoar caused by involuntary nocturnal trichophagia and trichotillomania in a female adolescent

INTRODUCTION AND IMPORTANCE: Gastric trichobezoar consist of the accumulation of chewed hair in the stomach and can extend to other structures of the digestive tract. The relevance of this entity is that it affects the process of nutrition and digestion, and depending on the size and distension of the digestive tract structures, it can cause perforation, infections, cholangitis and obstructive jaundice, intussusception and pancreatitis. CASE PRESENTATION: We present the case of a 15-year-old female patient came to the emergency department with a clinical picture of 8 h of evolution, abundant vomiting and lack of appetite for more than 15 days. Physical examination revealed a palpable mass in the epigastrium and left hypochondrium, without pain. Elective laparotomy was performed with findings of a mass of hard consistency and well organized with gastric shape, with hairs intertwined throughout its thickness, weighing 385 g. CLINICAL DISCUSSION: Currently, there are gaps in the evidence on the best approach to this condition, although both laparoscopic and endoscopic techniques and open surgery have been used, with satisfactory results. However, for the definitive solution of the primary cause, the surgical team must investigate further to avoid recurrence and greater burden of disease in the future. CONCLUSION: Gastric trichobezoar may be caused by involuntary nocturnal trichotillomania. Trichobezoar can seriously compromise the nutritional and physical condition of the affected person. The surgical team can inquire about causes of psychological or psychiatric origin, which may explain the development of trichobezoar, giving an answer to the primary cause and avoiding recurrence.