Open Journal of Gastroenterology, 2012, 2, 206-208 OJGas http://dx.doi.org/10.4236/ojgas.2012.24041 Published Online November 2012 (http://www.SciRP.org/journal/ojgas/ ) An unusual cause of gastric outlet obstruction in a young girl: Trichobezoar * Mahdi Bouassida 1# , Hédi Charrada 2 , Mohamed Fadhel Chtourou 1 , Lamine Hamzaoui 3 , Mohamed Monji Mighri 1 , Mohamed Msaddak Azzouz 3 , Hassen Touinsi 1 , Sadok Sassi 1 1 Department of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia 2 Department of Reanimation, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia 3 Department of Gastrology, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia Email: # bouassidamahdi@yahoo.fr Received 16 August 2012; revised 22 September 2012; accepted 10 October 2012 ABSTRACT Trichobezoars are an infrequent form of bezoars formed from ingested hair. They are more common in adolescent females with history of trichotillomania. Exceptionally, it can occur in young children making the diagnosis difficult. We report the case of a 6-year- old girl with a history of abdominal pain, distension, weight loss, and attacks of vomiting. Upper gastroin- testinal endoscopy revealed a trichobezoar occupying almost the whole gastric cavity. The gastric bezoar was removed by surgery. Gastric trichobezoar is ex- ceptional in young children and can lead to stunting and gastric outlet obstruction. After definitive surgi- cal or endoscopic treatment, pediatric psychiatric consultation should be opted for any mental disorder and for prevention of further recurrence. Keywords: Trichobezoar; Young Children; Gastric Outlet Obstruction; Trichotillomania 1. INTRODUCTION Trichobezoars are collections of hair which accumulate and remain within the gastrointestinal tract for extended periods. They occur so rarely that their true incidence is unknown. Trichobezoars occur more frequently in wo- men between the ages of 13 - 20 and often coexist with learning disabilities or psychiatric illness. These bezoars are typically found in the stomach but may also occur in the small or large bowel. Trichobezoar have variable presentation from chronic anorexia and failure to thrive to abdominal pain, vomit- ing, and acute obstruction. The treatment of trichobezoar can be endoscopic or laparoscopic. If large open removal is required. This may require both gastrotomy and en- terotomy if particularly extensive. It is important to refer for psychotherapy/psychiatric input after removal due to the risk of recurrence. We report the case of a 6-year-old girl having a gastric outlet obstruction with stunting due to a huge gastric trichobezoard. We discuss contemporary methods in di- agnosis and management of the condition. 2. CASE REPORT A 6-year-old girl was referred to our department with a history of abdominal pain, distension, weight loss, and attacks of vomiting of 6 months duration. The pain in- creased in severity, became localized in the epigastric area and was associated with nausea and vomiting. On examination, she was 15 kg in weight (–2 standard de- viation) and 105 cm in height (–2 standard deviation). There was no alopecia. Abdominal examination revealed a non-tender smooth abdominal mass in the left upper quadrant emerging from beneath the left costal margin and extending over the midline. Upper gastrointestinal endoscopy revealed a trichobezoar occupying almost the whole gastric cavity. Removal of the trichobezoar endo- scopically failed as it was possible to pull only few fibers of this huge ball of hair. Laparotomy was planned and was carried out through an upper midline incision. A large 18 × 4 cm J-shaped foul-smelling black bunch of hairs, about 200 g, was retrieved through a longitudinal anterior gastrotomy (Figure 1). There were no other daughter bezoars. The patient was tolerating a general diet until 5 th day after the operation and was discharged to her home on 7 th postoperative day. Psychiatric consul- tation was advised and child was followed up for a pe- riod of 1 year. No recurrence occurred. 3. DISCUSSION Trichobezoars are an infrequent form of bezoars formed from ingested hair. The common presentation of tricho- bezoar is in a young female usually with an underlying * Competing interests: no competing interests to declare. # Corresponding author. OPEN ACCESS