Gastric ulcer from trichobezoar

CaseA 77-year-old woman with a history of schizophrenia presented to the hospital with epigastric pain for two weeks associated with a 40-pound weight loss over the past six months.Physical examination showed thinning of the hairline (Figure 1A) and tenderness at the epigastrium.Laboratory tests showed iron deficiency anemia and hemoglobin 10.7 g/dL.Computed tomography of the abdomen with contrast showed abnormal gastric wall thickening and heterogenous mass within the stomach (Figure 1B andC).Esophagogastroduodenoscopy showed a large amount of hair in the gastric body and antrum along with one 15 mm clean based ulcer at the anterior wall of the stomach (Figure 2).Abiopsy from the gastric ulcer showed no evidence of malignancy.