Ahmad Zeeshanuddin, Sharma Apoorv, Ahmed Minhajuddin, Vatti Vikram
Department of Surgery, Gandhi Medical College, Bhopal, Madhya Pradesh, India.
Department of Pediatrics, Holy Family Hospital, New Delhi, Delhi, India.
Iran J Med Sci. 2016 Jan;41(1):67-70.
Trichobezoars are impactions of swallowed hairs in the stomach and occasionally in the intestine. They occur in emotionally disturbed, depressed, or mentally retarded patients who have trichotillomania and trichophagia. Trichobezoars are usually diagnosed on CT scan or upper GI endoscopy. They can give rise to complications like gastroduodenal ulceration, haemorrhage, perforation, peritonitis, or obstruction, with a high rate of mortality. The treatment is endoscopic, laparoscopic, or surgical removal and usually followed by psychiatric opinion. Herein, we report a case of gastric trichobezoar presenting as gastric perforation in a patient of trichotillomania and trichophagia that was accidentally found on laparotomy. As the patient was in shock on admission, relevant history of trichophagia could not be elicited. Henceforth, she was operated for perforation peritonitis. Trichobezoar was discovered intraoperatively and removed. The perforation was repaired with Graham's omental patch. Postoperatively, history of trichophagia was corroborated with scarring alopecia of scalp. Trichobezoars is usually seen in adolescent girls, often with an underlying psychiatric or social problem. Laparotomy is the gold standard treatment. Surgical treatment should be followed by behavioral and psychiatric treatment. The patient should be vigilantly monitored for this impulsive disorder, as recurrences are common.
毛发石是胃内，偶尔也在肠道内，由吞食毛发形成的团块。它们发生在患有拔毛癖和食毛癖的情绪紊乱、抑郁或智力发育迟缓的患者中。毛发石通常通过CT扫描或上消化道内镜检查来诊断。它们可引发诸如胃十二指肠溃疡、出血、穿孔、腹膜炎或梗阻等并发症，死亡率很高。治疗方法是通过内镜、腹腔镜或手术取出，通常随后还需要征求精神科意见。在此，我们报告一例在剖腹手术中意外发现的，表现为胃穿孔的毛发石病例，患者患有拔毛癖和食毛癖。由于患者入院时处于休克状态，无法得知其食毛癖的相关病史。因此，她接受了穿孔性腹膜炎手术。术中发现毛发石并将其取出。穿孔用格雷厄姆网膜补片修复。术后，食毛癖病史得到头皮瘢痕性脱发的证实。毛发石通常见于青春期女孩，往往伴有潜在的精神或社会问题。剖腹手术是金标准治疗方法。手术治疗后应进行行为和精神治疗。由于复发很常见，应对该冲动障碍患者进行密切监测。
