Gastric ulceration and perforation secondary to large trichobezoar - A case report describing the role of magnetic resonance imaging in diagnosis

M M Hennessy; I Ivanovski; C B Ó Súilleabháin

doi:10.1016/j.ijscr.2018.01.004

Gastric ulceration and perforation secondary to large trichobezoar - A case report describing the role of magnetic resonance imaging in diagnosis

Int J Surg Case Rep. 2018:43:25-28. doi: 10.1016/j.ijscr.2018.01.004. Epub 2018 Feb 10.

Authors

M M Hennessy¹, I Ivanovski², C B Ó Súilleabháin³

Affiliations

¹ Department of Surgery, Mercy University Hospital, Cork, Ireland. Electronic address: mhennessy@muh.ie.
² Department of Surgery, Mercy University Hospital, Cork, Ireland. Electronic address: Ivan.Ivanovski1@hse.ie.
³ Department of Surgery, Mercy University Hospital, Cork, Ireland. Electronic address: cbosullivan@muh.ie.

Abstract

Introduction: Trichotillomania and trichotillophagia can result in huge intraluminal coagulations of hair. Rarely, these can present with gastric perforation. This work has been reported in line with the SCARE criteria (Agha et al., 2016) [1].

Presentation of case: We report the case of a 15 year old girl who attended the emergency department with abdominal pain and vomiting. Ultrasound abdomen and pelvis identified free fluid within the pelvis concerning for inflammatory bowel disease. A subsequent magnetic resonance enterography (MRE) demonstrated a giant gastric trichobezoar which resulted in gastric perforation necessitating laparotomy and gastrotomy. The patient recovered well from the surgery and was reviewed by the psychiatry service prior to discharge.

Discussion: Trichobezoar is a challenging diagnosis and as clinician, we must always include it in our differential diagnosis. The clinical presentation, signs and symptoms depend on the size of the trichobezoar and the presence of complications. Management is almost always surgical.

Conclusion: This case illustrates the infrequent perforation risk of gastric bezoars and the important role of magnetic resonance imaging in diagnosis, particularly in a population who must not be exposed to excessive radiation.