trichobezoar

Trichobezoar is a type of bezoar consisting of ingested hair that accumulates in the gastrointestinal tract, most commonly in the stomach. It forms when hair, which is resistant to digestion, is swallowed (trichophagia) and gradually coalesces with mucus, food debris, and other materials. Hair may collect into a compact mass that fills the stomach and can extend into the small intestine in some cases.

Clinical presentation includes abdominal fullness, epigastric pain, early satiety, nausea, vomiting, weight loss, and, in severe cases, signs of gastric outlet obstruction. When the mass extends into the small intestine, a condition known as Rapunzel syndrome, patients may experience obstructive symptoms and malabsorption.

Risk factors include psychiatric conditions such as trichotillomania and trichophagia, often affecting adolescents or young adults, with a higher representation among females in case reports.

Diagnosis is established through imaging and endoscopy. Upper gastrointestinal endoscopy confirms presence and permits assessment of size and location, and may be therapeutic for small masses. Imaging modalities such as computed tomography or ultrasound can reveal a intragastric mass with characteristic features; radiographs may be non-specific.

Treatment depends on size and location. Small, accessible trichobezoars may be removed endoscopically, but large bezoars typically require surgical removal, commonly via laparotomy or laparoscopy. Postoperative care should address the underlying psychiatric condition to prevent recurrence, through psychotherapy, behavioral therapy, and, in some cases, pharmacologic therapy.

Prognosis is generally good after removal, but recurrence can occur if trichotillomania or trichophagia persists. Multidisciplinary follow-up is recommended.