IJCRR - 6(17), September, 2014
MULTIPLE TRICHOBEZOAR (GASTRIC and ILEAL) PRESENTING AS INTESTINAL OBSTRUCTION: CASE STUDY OF TWO PATIENTS
Author: Vineet Choudhary, Ravi Kumar Mathur, Sadhna Mathur, Brijesh Singh
Aim: We are presenting two rare cases of simultaneous occurrence of Gastric and Ileal trichobezoar presenting with intestinal obstruction.
Case Report: First case is 22 year old female with 6 months pregnancy complicated by intestinal obstruction due to multiple trichobezoars, Gastric and Ileal, which were removed successfully by exploratory laparotomy. Pregnancy and simultaneous occurrence of gastric and Ileal trichobezoar presenting as Intestinal obstruction makes this case rare and interesting. The second case is a 10 year old girl presenting with intestinal obstruction due to trichobezoars in both Gastric and Ileum. In this patient in iew of the clinical history of trichophagia, trichotillomania, radiological imaging studies suggestive of intestinal obstruction due to trichobezoar; Exploratory laparotomy done which revealed simultaneous Gastric and Ileal trichobezoar which were successfully removed.
Discussion: Isolated Gastric trichobezoar, those with extension into the duodenum and small intestinal trichobezoars have been described in the literature however the presence of discrete gastric and intestinal trichobezoars are rarely presented. Conclusion: These cases emphasize the importance of careful clinical history, role of radiological studies including USG, Barium contrast study, complete intraoperative evaluation of intestine at the time of dealing with a Gastric trichobezoar in diagnosis of trichobezoar.
Keywords: Trichophagia, Trichotillomania, Bezoar, Trichobezoar, Intestinal obstruction, Simultaneuos
Vineet Choudhary, Ravi Kumar Mathur, Sadhna Mathur, Brijesh Singh. MULTIPLE TRICHOBEZOAR (GASTRIC and ILEAL) PRESENTING AS INTESTINAL OBSTRUCTION: CASE STUDY OF TWO PATIENTS International Journal of Current Research and Review. 6(17), September, 55-58
1. A Samad, M. Ahmed,and Z latif, “Bezoars” a review of Two cases ,”Journal of the college of Physicians and Surgeons, Pakistan, vol 7, no 6pp263-265,1997.
2. M.E. Rabie, A.R. Arishi, A Khan, H. Ageely, GA.S. El- Nasr, and M Faghl,” Rapunzel Syndrome: the unsuspected culprit” World Journal of Gastroenterology,vol 14, no7, pp1141-1143, 2008.
3. Safford S. Goldstein, James H. Lewis, Robin Rothstein, Intestinal obstruction due to bezoars, The American Journal of Gastroentrology, vol 79, No4, 1984:313-318.
4. American Psychiatric Association, Diagnostic and statistical manual of mental Disorders,American Psychiatric Association, Washington, DC,USA, 4th Edition, 2000.
5. G.A.Christenson and SJGow,”The characterization and treatment of Trichotillomania”Journal of clinical Psychiatry, vol 57, no8, pp42-49,1996.
6. C. Bouwer and D.J. Stein,” Trichobezoars in Trichotillomania: case report and literature review “Psychosomatic Medicine, vol 60,no5, pp658-660,1998.
7. Andrus CH, Ponsky JL. Bezoars: Classification, Pathophysiology, and treatment. American J. Gastroenterol.1988;83:476-478.
8. Krausz MM, Moriel EZ, Ayalon A, Pode D, Durst AL. Surgical aspects of gastrointestinal persiminon phytobezoar treatment Am J Surg. 1986 Nov;152(5):526-30.
9. Escamilla C, Robles-Campos R, Parrilla-ParcioP,LujanMompean J, Liron-RuizR, Torralba-Martnez JA. Intestinal obstruction and bezoars JA. Intestinal obstruction and bezoars J.Am. Coll Surg 1994;179:285-288.
10. Yao cc, Wong HH. Chen CC. Wang cc,Yang cc. Lincs. Laparoscopic removal of large Gastric Phytobezoar Surg. Laparosc Endosc percutan technique 2000;10:243-45.
11. Michael N. Margolies,Foreign Bodies and Bezoars,Oxford Text Book of Surgery 2000 vol 2:1339-1341.
12. Kurguzoup, Bezoars as a cause of Acute Small Intestinal Obstruction. Khirurgiia (Mosk)2004(12)18-21 ISSN:0023- 1207.
13. Mitchell S Cappel, David, Friedel Abdominal pain during Pregnancy. Gastroenterology Clinics of North America. March 2003:22-23.
14. Narindr K Kaushik, Yash P Sharma, Asha Neg, A Jaswal, Indian Journal of Radoilogy and Imaging 1999/vol 9/issue3/ pno137-139.
15. Robert S Sander, Andresa Todisco, Gastric Bezoars, Text Book of Gastroenterology, 1999,vol1:1551-1552.
16. Vaughan ED, Sawyers JL, Scott HW. The Rapunzel Syndrome. An unusual complication of intestinal bezoar.SURGERY.1968;63:339-343.
17. Malhotra A, Jones L,Drugas G. Simultaneous gastric and small intestinal Trichobezoar. Pediatric Emergency care 12/ 2008, 24(11)774-776.
18. Hoover R, Piotrowski J, St Pierre K, Katz A, Goistein AM. Simultaneous gastric and small intestinal Trichobezoars-a hairy problem.J Pediatric Surgery.2006,41(8)1495-1497.
19. Kovacs V. Bruncak P. Cseri J. Malatnec J Simultaneous bezoars in the stomach, ileum and caecum causing illleus in a 30 year old imbecile.case report Rozhi Chir 2002;81:248- 251.
20. Palanivelu C, Rangrajan M, Senthil Kumar R, Madan Kumar MV. Trichobezoars in the stomach and ileum and their laparoscopy assisted removal.a bizarre case. Singapor Med J 2007Feb;48(2):e37-9.
21. M.R. Phillips, S. Zaheer and G.T. Druges, “Gastric Trichobezoar: ”Case report and literature review” Mayo clinic proceedings, vol 73, no7, pp653-656,1998 GASTRIC and ILEAL TRICHOBEZOAR.