DOI: 10.14260/jemds/2014/2841 CASE REPORT J of Evolution of Med and Dent Sci/ eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 3/ Issue 25/June 23, 2014 Page 6928 TRICHOPHAGIA AND TRICHOBEZOAR IN A 12 YEAR OLD GIRL: A CASE REPORT Kumar Premjeet Madhukar 1 , Devendra Taide 2 , Radha Verma 3 , Manjusha Sailukar 4 , Zaffar Sayed 5 HOW TO CITE THIS ARTICLE: Kumar Premjeet Madhukar, Devendra Taide, Radha Verma, Manjusha Sailukar, Zaffar Sayed. “Trichophagia and Trichobezoar in a 12 year Old Girl: A Case Report”. Journal of Evolution of Medical and Dental Sciences 2014; Vol. 3, Issue 25, June 23; Page: 6928-6931, DOI: 10.14260/jemds/2014/2841 ABSTRACT: Trichobezoar consists of a compact mass of hair occupying the gastric cavity to a various extent. When the trichobezoar extends past the duodenum it is better referred to as Rapunzel syndrome. They occur in emotionally disturbed, depressed, or mentally retarded patients who have trichotillomania and trichophagia. It is almost exclusively seen in girls. An underlying functional or mechanical obstruction of the gastrointestinal tract (after gastric surgery, gastric dysmotility, for example) may predispose to bezoar formation in rare instances. Although trichobezoars are well described in terms of surgical diagnostic and procedure, there are only but very scarce reports on psychiatric literature, usually associated with trichotillomania. We present a clinical case of trichobezoar in a 12 year old female and discuss the most relevant aspects concerning this entity. KEYWORDS: Bezoar, Trichobezoar, Trichotillomania, Trichophagia. INTRODUCTION: Bezoar is a tightly packed collection of undigested material that is unable to exit the stomach. Most bezoars are of indigestible organic matter such as hair - trichobezoars; or vegetable and fruit the - phytobezoars; or a combination of both but other rare substances has been also been described in literature. The most frequent type of bezoar in adults is phytobezoar, while trichobezoars are more often found in children and teenage girls 1 . Trichobezoars, commonly occur in patients with psychiatric disturbances who chew and swallow their own hair. Only 50% will have history of trichophagia and usually they occur in emotionally disturbed, depressed or mentally retarded. Trichobezoars have been described in literature and they comprise 55% of all bezoars. In very rare cases the Rapunzel Syndrome hair extends through the pylorus into the small bowel causing symptom and sign of partial or complete gastric outlet obstruction 2 . Although trichobezoars are well described in terms of surgical diagnosis and procedure, there are only but scarce reports on psychiatric literature. This case report describes the case of a 12 years old female patient diagnosed with a trichobezoar who had a history of eating scalp hair for 5 years. CASE REPORT: A 12 year old girl presented to surgical OPD with abdominal lump for 3 years and dull aching pain for 1 year with history of weight loss. Her physical examination revealed the presence of a large, hard, solid mass from epigastric to periumbilical region, mobile and painless with no other remarkable features. An abdominal ultra-sound revealed a highly reflective structure not allowing in-depth evaluation. Barium meal follow through suggested a huge mass in the stomach probably a trichobezoar [Fig. 1]. On counseling the patient and her family revealed the history of eating scalp hair for 5 years. An anterior gastrotomy with removal of bezoar was done which revealed the presence of human hair [Fig. 2]. The patient was counseled by psychiatrist and medicated with fluoxetine 20mg and risperidone 0.5mg, showing “mild improvement” in such episodes.