Buils F.J1,2*, Renau G1, Sánchez Cano J.J1, Menéndez J1, García MA1, Lobo N1, Haupt S1, Galiana M1 and Sánchez Marín A1,2
There are multiple causes of intestinal obstruction of mechanical origin, being a rare entity in young patients without underlying organic pathology or previous surgical interventions. The presence of a large bezoar in the gastric cavity as the origin of the obstructive condition is unusual, particularly that of trichobezoars, which is why we describe the following case We present a 19-year-old woman with a history of anxiety-depressive syndrome who has had a trichophagia disorder for the last year. Given the diagnosis of gastric sub-occlusive syndrome with diffi culty in ingestion secondary to large gastric bezoar, surgical intervention was decided to resolve the condition surgically.
Case Report
19-year-old patient, with a history of anxiety-depressive syndrome and who has had a trichophagia disorder for the last year. Consultation due to abdominal pain and distension, weight loss and food intolerance to solids that had been going on for weeks. On physical examination, a painless crepitant mass was palpated in the epigastriummesogastrium. Complementary explorations: -Analysis: A hemoglobin of 9mg/dL stands out. -Fibrogastroscopy: Foreign body at the entrance to the gastric chamber that does not allow the endoscope to advance. -Abdominal CT: Foreign body that occupies the entire gastric cavity, creating a mass effect that even causes displacement of the intestinal loops (Figure 1).
Given the suspicion of gastric trichobezoar, urgent deferred surgery was performed using an open approach, revealing a stomach with great distension and solid contents (Figure 2). A longitudinal gastrotomy is performed on the gastric body, the clinical suspicion of trichobezoar is con????irmed and the foreign body, which reaches a size of 20 x 20 cm and weighs 1850 g, is removed (Figure 3 & 4). The rest of the bowel is explored if other affected segments are found. Findings of mucosal erosion in the antrum suggestive of foreign body contact. During the immediate postoperative period, anemia was observed that required the transfusion of packed red blood cells. After this, the patient progressed well and was discharged on the 6th postoperative day with close follow-up by psychiatry.
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