S5975 Trusting Your Gut: A Hairy Situation

Introduction: Trichobezoar, derived from the Greek word trich, meaning hair, is a mass formed by the accumulation of ingested human hair within the gastric lumen. Continuous ingestion, often mixed with food particles, leads to an increase in volume, creating gastric outlet obstruction, abdominal pain, distension, and vomiting. Trichobezoars commonly affect young females and are associated with trichotillomania or trichophagia. Diagnosis can be established through endoscopy or imaging. We present a case of trichobezoar in a young girl, diagnosed only through endoscopy after multiple inconclusive imaging studies. Case Description/Methods: A 7-year-old previously healthy girl presented with a 3-week history of intermittent upper abdominal pain, early satiety, and 4.5-kilogram weight loss. There was no vomiting, diarrhea, or altered bowel habits. She was afebrile with normal vital signs. Lab work revealed normal white blood cell count (11.6 × 10³/μL), hemoglobin (13.1 g/dL), mild thrombocytosis (499 × 10³/μL), mildly elevated lipase (107 U/L) and iron deficiency (Fe 17 μg/dL, total iron-binding capacity 345 µg/dL, iron saturation 5%). Abdominal radiography and ultrasound were normal. Abdominal and pelvic magnetic resonance imaging showed significant gastric and proximal duodenal distention, suggestive of superior mesenteric artery syndrome. A subsequent upper gastrointestinal series revealed duodenal dilation with a gastric filling defect. A diagnostic esophagogastroduodenoscopy (EGD) confirmed a large trichobezoar with surrounding ulceration. She underwent a laparoscopic gastrotomy with removal of the mass. Postoperatively, her parents reported a habit of sucking and ingesting her hair when anxious, with changes in her hairline suggesting trichotillomania. She was discharged home on a proton-pump inhibitor and referred to behavioral therapy. At follow-up, she regained 2.3 kilograms with no further reports of trichotillomania. Discussion: Trichobezoar should be considered in the differential diagnosis of children with unexplained gastrointestinal symptoms, weight loss, or alopecia. Imaging may aid in diagnosis but is often inconclusive. EGD remains the gold standard for both diagnosis and potential treatment. Early recognition, surgical management, and appropriate psychiatric support are crucial to preventing complications and recurrence.