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152 GASTRIC TRICHOBEZOAR: AN UNUSUAL CASE OF PANCREATITIS AND A LITERATURE REVIEW ON THE MANAGEMENT OF BEZOARS J deBruyn, D Boctor Gastric trichobezoars are an unusual cause of pancreatitis. Patients with a gastric bezoar may be asymptomatic or may range in presentation from an abdominal mass to an "acute abdomen". If undiagnosed, gastric bezoars may lead to significant complications including pancreatitis, gastric ulceration, bleeding and perforation, small bowel obstruction, and intussusception.
Division of Pediatric Gastroenterology and Nutrition, Alberta Children's Hospital, University of Calgary, Calgary, Alberta
We present the case of a 9-year-old girl with a history of chronic post-prandial epigastric pain associated with weight loss, early satiety, emesis, and iron-deficiency anemia. She had a history of trichotillomania and trichophagia 3 years prior which prompted her parents to shave her head, causing resolution of the problem. However, she recently passed a bowel movement with hair mixed in the stool.
At presentation, the patient had severe acute-on-chronic epigastric pain and emesis. She had a large hard epigastric mass (12 cm x 8 cm) with no evidence of alopecia, and an elevated serum lipase (1167 U/L). X-ray and CT of her abdomen revealed a J-shaped mass occupying her entire stomach. She was diagnosed with pancreatitis and a gastric trichobezoar. Her symptoms of pancreatitis resolved with conservative management. Due to the size and nature of the bezoar, it was extracted via laparotomy and gastrotomy. The patient recovered fully.
A large gastric trichobezoar may cause pancreatitis by exerting mass effect on the pancreas or by obstructing the ampulla of Vater with a tail of hair in the small intestine ("Rapunzel syndrome"). Medical management of bezoars includes dissolution therapy; however this is rarely effective in trichobezoars. Endoscopic fragmentation is often possible with small bezoars. However treatment of large gastric trichobezoars remains directed towards surgical management, as in this case.