Hidden in plain sight: diagnostic challenges of gastric trichobezoar in an adolescent—a case report

Gastric trichobezoars are rare and often pose a diagnostic challenge due to their nonspecific symptoms and association with underlying psychiatric disorders. In this case, a 14-year-old girl presented with a 3-month history of intermittent abdominal pain, vomiting, early satiety, and a palpable epigastric mass. Although she initially denied any history of trichophagia or trichotillomania, further questioning revealed a year-long habit of hair ingestion that began after an appendectomy. Contrast-enhanced computed tomography imaging confirmed a large gastric trichobezoar extending into the duodenum. Surgical removal of the mass was performed, followed by psychiatric and nutritional counseling. This case highlights the phenomenon of "hidden in plain sight," where behavioral causes of physical symptoms are initially overlooked. It emphasizes the importance of maintaining a high index of suspicion for trichobezoars in adolescents with vague gastrointestinal complaints and reinforces the need for a multidisciplinary approach to ensure accurate diagnosis, effective treatment, and comprehensive follow-up care.