A 39‐year‐old African American woman presented with nausea, postprandial emesis, early satiety, abdominal distension/pain for 1 week, and 2 days of hematemesis. Physical exam revealed a diffusely distended, tender abdomen and a firm, immobile 8 × 12 cm abdominal mass in the left upper quadrant. A complete blood count was significant for a hemoglobin and hematocrit of 6.5 and 21.5, respectively. She was transfused 2 units of packed red blood cells. CT revealed gastric trichobezoars. On further questioning, she revealed a 28‐year history of trichotillomania and trichophagia and reported consuming a quart‐sized bag of hair daily that she obtained from barber shops. Esophagogastroduodenoscopy demonstrated 3 large trichobezoars within the stomach and a 1‐cm non‐bleeding ulcer on the greater curvature, without evidence of complete gastric outlet obstruction or Rapunzel syndrome (tracking beyond the pylorus). The trichobezoars were deemed too large to be removed endoscopically. She was started on Prozac 20 mg by mouth daily to decrease the compulsion to consume hair, Coca‐Cola 300 mL 3 times a day to decrease the size of the trichobezoars in anticipation of surgical removal, and metoclopramide 10 mg by mouth twice a day. Psychiatric management was initiated.
Trichobezoars are accumulations of hair typically located in the stomach that may track beyond the pylorus into the small bowel. This finding is associated with the psychiatric disorders trichotillomania and trichophagia, which usually occur in young females. When not recognized early, trichobezoars may continue growing because of persistent hair consumption and cause gastric erosion, ulceration, or gastric outlet obstruction (Gorter RR, Kneep‐kens CMF, Mattens ECJL, Aronson DC, Heij HA. Management of trichobezoar: case report and literature review. Ped Surg Int. 2010;26:457–463). In this case, the significant size of this patient's trichobezoars resulted in partial pyloric obstruction, leading to gastrointestinal (GI) symptoms. We propose that the trichobezoars eroded the gastric mucosa causing ulceration. During 1 week of vomiting, the marked increase in intra‐abdominal pressure was transmitted to the esophagus, which likely caused Mallory–Weiss syndrome, manifesting as hematemesis. The patient's malnutrition resulted in severe iron ‐deficiency anemia, which was exacerbated by hematemesis and gastric ulceration.
Although a rare occurrence, trichobezoars must be considered in a differential diagnosis of a patient, especially in young females presenting with either an abdominal mass or nonspecific GI symptoms in the context of an upper GI bleed. We also highlight the importance of managing trichobezoars medically and with psychiatric counseling prior to surgical removal in order to alleviate GI symptoms and prevent reoccurrence. 1..
O. Eydlin ‐ none; V. Perel ‐ none
To cite this abstract:Eydlin O, Perel V. Trichobezoars As a Cause of Upper Gastrointestinal Bleeding: A Case Presentation. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 270. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/trichobezoars-as-a-cause-of-upper-gastrointestinal-bleeding-a-case-presentation/. Accessed March 31, 2020.