276 Unusual presentation of trichobezoar in a previously healthy adolescent patient

• Published in: Archives of disease in childhood 2022-08, Vol.107 (Suppl 2), p.A250-A251
• Main Authors: Alassaf, Anood, Hassan, Manasik
• Format: Article
• Language: English
• Subjects: Abdomen; Abstracts; Adolescents; Appetite loss; Bezoars; Biopsy; Body weight loss; Case reports; Chronic pain; Constipation; Differential diagnosis; Duodenum; Gastrointestinal tract; Hair; Inflammatory bowel diseases; Ingestion; Intestinal obstruction; Intussusception; Lymph nodes; Lymphoma; Malignancy; Medical Evaluation; Mental disorders; Morphine; Pain; Patients; Pediatrics; Physical Examinations; Scientific Concepts; Small intestine; Stomach; Teenagers
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2022-rcpch.404

AimsTo describe a case of an 11 years old girl with complicated intestinal obstruction caused by trichobezoar.MethodsWe report a case of Trichobezoar presenting with severe chronic abdominal pain and intestinal obstruction leading to toxic megacolon. We describe the management of this case and include the radiological image and surgical samples pictures. (figure 1A and figure 1B ).The patient is an 11-year-old female, with an unremarkable medical history, who presented with 2 months history of persistent central abdominal pain and episodes of severe short-lasting exacerbation. In addition, she had significantly decreased appetite, weight loss, and progressively worsening constipation. On examination, she was cachectic, pale, with palpable soft ill-defined mass in the left lower abdomen. Multiple ultrasound abdomen studies showed intermittent intussusception; however, MRI was concerning for malignancy as it showed Multiple segments of significant wall thickening involving the small bowels with subacute/incomplete bowel obstruction findings. For this reason, abdominal lymph nodes were taken for biopsy to rule out small bowel lymphoma. The pathological report was inconclusive. At that time, the patient was experiencing severe continuous abdominal pain for which morphine was given. The patient became sicker and was not tolerating any oral intake. The abdominal X-ray at this point showed toxic megacolon (figure 1A). Urgent surgical laparotomy was done, and findings were intussusception involving a large segment of small bowel from and string (bezoar) going from the duodenojejunal junction down to the ascending colon.the entire small bowel was intussuscepted over the short thread of hair that measures approximately 30 cm. this tight string of hair caused a shearing effect cutting through the bowel wall causing fistulation between multiple bowel segments. multiple non-viable segments of the small bowel were resected.the stomach was visualized with scope, which showed trichobezoar resected surgically (figure 1B).Abstract 276 Figure 1AThere is dilated air filled upper bowel lobe at the mid and right abdomen, with masslike appearance at the left and mid abdomen suggestive of thickened bowel with intussusception. Minimal air seen in the rectum. Findings may suggest partial obstructionAbstract 276 Figure 1BTrichobezoar measuring approximately 30 cm, extending from the stomach to the duodenumResultsTrichobezoar is a collection of hair in the gastrointestinal tract, usu