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CASE REPORT
Hsien-Pin Sun
Division of General Surgery, Department of Surgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
ABSTRACT
Bezoars are masses of solidified organic or nonbiological material commonly found in the stomach and small bowel. Although
phytobezoars are now the most common type reported and are usually associated with previous gastric surgery and abnormal
emptying, trichobezoars still occur most frequently in younger patients. More than 90% are found in girls, usually in adolescence.
We present a 9-year-old girl with concomitant giant gastric trichobezoar and ileal trichobezoar causing intestinal obstruction. Sur-
gical retrieval of these trichobezoars was done successfully. The girl recovered well and no recurrence was noted. (Tzu Chi Med J
2005; 17:433-436)
A bezoar is a concretion of material ingested over A 9 year-old, short-haired girl presented in the
time in the lumen of the digestive tract. It is usually emergency department with complaints of abdominal
formed in the stomach. The mass, or part of it, may pass pain and vomiting for several weeks. The girl was rela-
into the small intestine and then become impacted [1]. tively thin. She had recurrent attacks of mild abdominal
Bezoars have been classified into four types based on pain. The abdominal pain was cramping in nature and
their composition: phytobezoar (vegetable), trichobezoar was relieved by vomiting several hours after eating.
(hair), lactobezoar (milk curd), and miscellaneous Physical examination revealed a huge, non-tender,
(medications, tissue paper, shellac, tar, sand, and fungus) mobile, firm protruding mass occupying the epigastric
[2]. Phytobezoars are now the most common type re- and left subcostal regions of the abdomen. Her lower
ported and are usually associated with previous gastric abdomen was distended and bowel sounds were
surgery and abnormal emptying. However, trichobezoars hyperactive. Her vital signs were normal. Laboratory
occur more frequently in children [3]. More than 90% data including complete blood cell count, electrolytes,
present in girls, usually in adolescence. We present a liver function tests, blood urea, serum creatinine, and
case of gastrointestinal trichobezoar- induced intestinal serum amylase were all within the normal range. KUB
obstruction. showed local ileus over the lower abdomen (Fig. 1).
Abdominal computed tomography showed a heteroge-
nous intraluminal mass in the stomach with characteris-
tic minute air bubbles within the mass (Fig. 2). Her
Received: July 26, 2005, Revised: August 16, 2005, Accepted: August 25, 2005
Address reprint requests and correspondence to: Dr. Hsien-Pin Sun, Division of General Surgery, Department of Surgery,
Buddhist Tzu Chi General Hospital, 707, Section 3, Chung Yang Road, Hualien, Taiwan
pists should be consulted postoperatively as trichobezoar 11. Gayer G, Jonas T, Apter S, et al : Bezoars in the stom-
may recur if underlying emotional stress factors are not ach and small bowel--CT appearance. Clin Radiol 1999;
resolved [24]. 54:228-232.
12. Shawis RN, Doig CM: Gastric trichobezoar associated
with transient pancreatitis. Arch Dis Child 1984; 59:994-
995.
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