Surgical Management of a Giant Gastric Trichobezoar in a Teenager With 17β-Hydroxysteroid Dehydrogenase 3 Deficiency: A Case Report

Trichobezoars are rare gastric masses composed of ingested hair, most commonly observed in adolescents with underlying psychiatric conditions. Diagnosis is often delayed due to non-specific gastrointestinal symptoms and the patient's reluctance to disclose trichophagia. Large bezoars may extend into the small intestine and typically require surgical intervention. We report the case of a teenager with a disorder of sex development (DSD) who presented with progressive abdominal pain, persistent vomiting, and significant weight loss. Endoscopy revealed a large gastric trichobezoar extending beyond the pylorus. The patient had a known history of trichophagia and was under psychiatric care. Following post-endoscopy haemodynamic instability, she underwent emergency surgery. The trichobezoar was successfully removed via a laparoscopic-assisted mini-laparotomy, and the gastrotomy was closed in two layers. Her postoperative course was uneventful, and she was discharged with appropriate psychiatric follow-up. This case highlights the importance of early clinical suspicion in patients with persistent gastrointestinal symptoms and psychiatric comorbidities. Surgical extraction remains the treatment of choice for large bezoars, and multidisciplinary care is essential to optimise recovery and prevent recurrence.