Huge Gastric and Ileal Trichobezoars Causing Small Bowel Obstruction

The bezoar is the accumulation of undigestible food or fibre in the digestive tract, most commonly in stomach and proximal small bowel. Trichobezoar is an accumulation of hair. They may present as an independent mass in small bowel or with or without an extension into the small bowel. The trichobezoars are well described, in terms of surgical, diagnostic, and therapeutic procedures. However, there are very few reports on psychiatric literature and a dual presentation of gastric and ileal trichobezoars. The authors present a case report of a gastric with an ileal trichobezoar that is rarely reported in literature. A young girl with a history of trichophagia presented with features of small bowel obstruction. On physical examination, there was abdominal distension with a huge mobile mass on left side of umbilicus extending up to the epigestrium. There were dilated small bowel loops on abdominal radiograph. Ultrasound-abdomen also showed fluid-filled dilated small bowel loops. She was further investigated with CT scan abdomen, which showed a large mass occupying whole of the stomach and another mass in distal ileum causing small bowel obstruction, suggestive of trichobezoar. Through anterior wall gastrotomy, huge trichobezoar was removed from stomach; and through distal ileal entrotomy, ileal trichobezoar was removed.