S3624 Tangled Trouble: Acute Pancreatitis Caused by a Trichobezoar

Introduction: Acute pancreatitis (AP) in children is an uncommon but increasingly recognized condition, with mechanical obstruction representing a rare yet notable cause. Trichobezoars, gastric masses of ingested hair commonly seen in adolescent females with underlying psychiatric conditions like trichophagia, are an exceedingly rare cause of AP. The proposed mechanism involves mechanical obstruction of the ampulla of Vater by duodenal extension of the bezoar. We present a case of AP in an adolescent woman caused by a trichobezoar, emphasizing the importance of considering rare mechanical etiologies and multidisciplinary management. Case Description/Methods: We report the case of a 15-year-old woman presenting with acute pancreatitis characterized by abdominal pain, bilious vomiting, and a significantly elevated lipase of 17,598 U/L. Imaging revealed a suspected gastric bezoar extending into the duodenum, dilated biliary and pancreatic ducts, and a peripancreatic fluid collection. Further history revealed prior trichophagia. Surgical exploration confirmed a large trichobezoar extending from the stomach into the duodenum, with a second separate obstructing mass near the ligament of Treitz. Both bezoars were removed via gastrostomy and enterotomy, alongside cholecystectomy and jejunostomy tube placement. The patient’s symptoms and laboratory abnormalities rapidly resolved postoperatively. She was referred for psychiatric follow-up to address underlying trichophagia. Discussion: This case illustrates a rare cause of pediatric AP—mechanical obstruction by a trichobezoar. Fewer than a handful of such cases have been reported. The obstructing mass likely caused compression of the ampulla of Vater, impairing pancreatic drainage and triggering inflammation. Diagnosis can be delayed due to nonspecific symptoms and difficulty eliciting psychiatric history. Imaging, particularly magnetic resonance cholangiopancreatography (MRCP) and computed tomography, is essential for diagnosis. Surgical removal remains the mainstay of treatment for large bezoars, and rapid improvement after surgery supports a causal relationship. Clinicians should maintain a high index of suspicion for bezoars in pediatric AP with unclear etiology, especially in adolescents with subtle signs of trichophagia. Early multidisciplinary management is critical to prevent recurrence and reduce morbidity.