Gastric trichobezoars in two pediatric girls: A case report.

BACKGROUND: Bezoars are gastrointestinal foreign bodies, often found in the stomach, composed of indigestible materials. Trichobezoars are rare gastrointestinal masses composed of ingested hair, primarily affecting young females with underlying psychiatric conditions such as trichotillomania and trichophagia. If left untreated, they can result in significant complications including: abdominal pain, gastric ulcers, gastrointestinal bleeding, obstruction, and even perforation.

CASE PRESENTATION: We present two cases of Arab pediatric patients-a 9-year-old and a 10-year-old girl-who presented with nonspecific gastrointestinal symptoms and palpable abdominal masses. Both had a history of trichophagia, with one of the cases suffering from trichotillomania as well. Endoscopic evaluation revealed large gastric trichobezoars without intestinal extension. Due to the size and composition of the masses, chemical dissolution was not feasible, and both patients underwent successful open gastrotomy.

CLINICAL DISCUSSION: Trichobezoars are often underdiagnosed due to their nonspecific symptoms and the rarity of the condition. The diagnosis should be considered in pediatric patients, especially females, presenting with unexplained gastrointestinal symptoms and a behavioral history of hair ingestion. While chemical and endoscopic approaches are applicable in select cases, they are often ineffective in large, dense trichobezoars. Surgical removal remains the most reliable treatment in such presentations. Early psychiatric intervention is essential to address underlying disorders and prevent recurrence.

CONCLUSION: Although trichobezoar is a rare condition, it should be considered in the differential diagnosis, particularly in young girls with behavioral conditions. For large gastric trichobezoars, surgery remains the definitive treatment, while other bezoar types may require alternative approaches.