Zhao Jiu-Ling, Zhao Wei-Chuan, Wang Yu-Shui
Department of Pediatrics, Tianjin Nankai Hospital Nankai Clinical School, Tianjin Medical University Department of Endoscopy, Tianjin Nankai Hospital, Nankai, Tianjin, China.
Medicine (Baltimore). 2017 Jan;96(3):e5969. doi: 10.1097/MD.0000000000005969.
Trichophytobezoars, which are composed of hair and plant fibers, are usually located in the stomach. They are often associated with trichophagia and trichotillomania. The most commonly reported methods of trichophytobezoar treatment are open surgery and laparoscopic retrieval; there are few reports of endoscopic removal of trichophytobezoars.
Twelve-year-old girl presented with a 3-day history of increasing upper abdominal pain, anorexia, and postprandial emesis. She had a 3-year history of pulling out and eating her own hair. Endoscopic examination showed a large intragastric trichophytobezoar measuring 10.5 cm × 3.5 cm in size, with extension of a few hairs through the pylorus.
The trichophytobezoar was packed with hair fibers and contained a hard core of mixed hair and vegetable fibers. After the core was cut, the trichophytobezoar was fragmented into pieces with the alternating use of a polypectomy snare and argon plasma coagulation. A small amount of hair and nondigestible food fibers was removed with grasping forceps during the initial procedure. The remaining hairball was loosened with biopsy forceps and was injected with sodium bicarbonate solution. The trichophytobezoar was removed completely at repeat endoscopy 5 days later. After 6 months of psychological intervention, the patient had no recurrence of trichophagia or trichophytobezoar.
Endoscopy with sodium bicarbonate injection is an effective and minimally invasive method of retrieving a gastric trichophytobezoar.
毛发植物性胃石由毛发和植物纤维组成，通常位于胃内。它们常与食毛癖和拔毛癖相关。最常报道的毛发植物性胃石治疗方法是开放手术和腹腔镜取出；内镜下切除毛发植物性胃石的报道较少。
一名12岁女孩，有3天的上腹部疼痛加剧、厌食和餐后呕吐病史。她有3年的拔自己头发并食用的病史。内镜检查显示胃内有一个大的毛发植物性胃石，大小为10.5厘米×3.5厘米，有几根毛发穿过幽门。
毛发植物性胃石充满毛发纤维，包含一个由毛发和植物纤维混合而成的硬核。在切开硬核后，交替使用息肉切除圈套器和氩离子凝固术将毛发植物性胃石破碎成碎片。在初始操作过程中，用抓钳取出少量毛发和不可消化的食物纤维。用活检钳将剩余的毛球松解，并注入碳酸氢钠溶液。5天后重复内镜检查时，毛发植物性胃石被完全取出。经过6个月的心理干预，患者没有再出现食毛癖或毛发植物性胃石复发。
内镜下注射碳酸氢钠是一种有效且微创的取出胃内毛发植物性胃石的方法。
