Trichobezoar: a rare cause of intestinal obstruction
Keywords:
bezoars, abdominal pain, intestinal obstruction, trichotillomaniaAbstract
Introduction: Bezoars are persistent deposits of undigested material in the digestive tract. They are intestinal foreign bodies formed by the concretion of food remnants or poorly digested material (plant fibers, hair, nails). They are usually located in the stomach, but can migrate to the intestine and cause an intestinal obstruction.
Objective: To present a case of trichobezoar as a rare cause of intestinal obstruction.
Case presentation: A 22-year-old female patient, white, with a history of hypothyroidism for 15 years, for which she receives treatment with levothyroxine, 1 tablet daily from Monday to Friday. Additionally, a history is noted that since the product of her pregnancy, she began ingesting hair, nails (trichophagia), (trichotillomania), and anoncillo seeds. She presents with cramping abdominal pain, nausea, vomiting, heartburn, anxiety, general malaise, weight loss, an epigastric mass, cessation of fecal matter, and no passage of gas. The computed tomography scan showed gastric and duodenal dilation up to its third portion, occupied by a heterogeneous mass with air inside and around its periphery. An exploratory laparotomy was performed, revealing the completely dilated and filled stomach, and a gastrostomy was performed, which showed a trichobezoar measuring 60 cm long x 18 cm wide.
Conclusions: Intestinal obstruction caused by trichobezoars is rare and presents a diagnostic challenge. A history of psychiatric disorders, generalized anxiety, or pica is frequently observed. Treatment for trichobezoar removal is not standardized; however, the preferred methods are laparoscopy and exploratory laparotomy.
References
1. Sulaiman Ambusaidi FM, Al-Yaqoubi M. Gastric bezoar. Int J Pediatr Adolesc Med [Internet]. 2020 [acceso: 22/01/2024]; 7(4): 199–200. Disponible en: https://pubmed.ncbi.nlm.nih.gov/33319020/
2. Martínez Valenzuela N, Hossein S, Hira D, Salas Izquierdo CC. El largo camino de la tricotilomania al síndrome de Rapunzel. Rev Cubana Cir [Internet]. 2022 [acceso: 22/01/2024]; 61(2): e1257. Disponible en: http://scielo.sld.cu/scielo.php?pid=S0034-74932022000200013&script=sci_arttext
3. Kurosu T, Tanabe S, Hasegawa R, Yano T, Wada T, Ishido K, et al. A giant trichobezoar extracted by laparoscopic and endoscopic cooperative surgery (LECS). Endosc Int Open [Internet]. 2018 [acceso: 22/01/2024];6(12): 1413–6. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30505935/
4. Harikrishnan S, Perumal S, Sachanandani K, Thiruvarul M, Sugumar C, Sathyanesan J, et al. A Modified Laparoscopic Technique for the Removal of Nonfragmentable Giant Gastric Trichobezoar. Niger J Surg Off Publ Niger Surg Res Soc [Internet]. 2020 [acceso: 22/01/2024];26(1):84. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32165844/
5. Hamid M, Chaoui Y, Mountasser M, Sabbah F, Raiss M, Hrora A, et al. Giant gastric trichobezoar in a young female with Rapunzel syndrome: case report. Pan Afr Med J [Internet]. 2017 [acceso: 22/01/2024];27. Disponible en: https://pubmed.ncbi.nlm.nih.gov/29187921/
6.Villalabeitia Ateca I, Alonso Calderón E, Alonso Carnicero P, Errazti Olartekoetxea G. Giant gastric trichobezoar in an adolescent patient. Cir Esp [Internet]. Ene 2021[acceso: 22/01/2024];99(1):65. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32216953/
7. Kwon HJ, Park J. Treatment of large gastric trichobezoar in children: Two case reports and literature review. Med (United States) [Internet]. 2023 [acceso: 22/01/2024];21;102(16): 33589.Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10118359/
8. Peñafiel-Palacios CN, Cañar-Cely BA, Ordoñez-Sanchez IE, Briones-Morales VE. Alteraciones psiquiátricas relacionadas con tricobezoar gástrico. Reporte de caso. Revista de Ciencias Médicas de Pinar del Río [Internet]. 2024 [acceso: 11/01/2026];28(1): e6497-e6497. Disponible en: https://revcmpinar.sld.cu/index.php/publicaciones/article/view/6497
9. Tonin KDS, Szczerbowski CR, Liskoski GH, Sedoski JV, Marques JS, Silva MPRD, et al. Tricobezoar gástrico e Síndrome de Rapunzel. Acervo Científico [Internet]. 2025 [acceso: 11/01/2026]; 25: e20310. Disponible en: https://acervomais.com.br/index.php/cientifico/article/view/20310
10. Forero Amézquita S, Atuesta Escobar S, Prieto Soler C, Celis LG. Tricobezoar gástrico: manifestación tardía de un trastorno de la conducta en la infancia. Acta Pediatr Mex [Internet]. 2025 [acceso: 11/01/2026];46(1):97-102. Disponible en: https://ojs.actapediatrica.org.mx/index.php/APM/article/view/2821
11 Arias GV. De la fábula a la realidad médica: El Síndrome de Rapunzel en la práctica clínica. Revista Científica Estudiantil de Cienfuegos Inmedsur [Internet]. 2026 [acceso: 11/01/2026];9(2026):434. Disponible en: http://www.inmedsur.cfg.sld.cu/index.php/inmedsur/article/view/434
12. Blanco Vargas J, Hernandez Sandoval E, Avilez Arias J, Esquer García M. Gastrointestinal obstruction due to Rapunzel’s Syndrome: Laparoscopic Approach. A Case Report. Cir Andal [Internet]. 2024 [acceso: 11/01/2026];35(4):449-51. Disponible en: https://www.asacirujanos.com/revista/2024/35/4/15
13. Sánchez Galindo B, Sánchez Galindo FJ. Obstrucción intestinal por bezoar asociado a consumo de cocaína: A propósito de un caso. Cirugía Andaluza [Internet]. 2023 [acceso: 11/01/2026];34(1):60-2. Disponible en: https://dialnet.unirioja.es/servlet/articulo?codigo=8905138
14. Cabezas RV. Tricotilomanía en dermatología: un enfoque integral. Actualización en hallazgos dermatoscópicos, tratamiento y comunicación de un caso clínico representativo. Dermatología Revista Mexicana [Internet]. 2025 [acceso: 11/01/2026];69(6). Disponible en: https://www.revisionporpares.com/index.php/Derma/article/view/10838
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