Introduction This is a case of a young girl presenting with an unusual cause for vomiting.
Case A 15 year old girl with diabetes mellitus presented to A&E with a history of vomiting. She had been managing her diabetes at home during the illness with advice from her diabetic nurse.
This young lady had been unwell for 4 days, tolerating small volumes of fluids but no solids. There has been no associated diarrhoea or pyrexia. Bowels had not been opened for 4 days but she was passing flatus. She was having intermittent hypoglycaemic episodes managed with glucose loaded drinks and reducing her insulin doses.
She also suffered with mesangiocapillary glomerular nephritis with hypertension. She was on Labetalol and basal bolus insulin regimen. She had no drug allergies.
She was an only child, home schooled in view of bullying in the past with a history of self harm.
In the department she was alert and chatting. Her BM 6.0. Examination was normal other than a large, firm palpable mass in the left upper quadrant of the abdomen. You could not get above the mass and it approached the midline, it was tender to palpation. Blood tests were essentially normal other than a slightly raised CRP.
An urgent CT abdomen was arranged which revealed a heterogenous, large intraluminal mass in keeping with a Trichobezoar.
Surgery was performed the following day and a 20×6 m, non-compressible trichobezoar was removed that was occupying almost the entire lumen of the stomach and extending into the duodenum. She returned from theatre with an NGT in situ with a plan to remain NBM for at least 48 hours.
This young lady had suffered from many emotional and behavioural problems in the past during which time she had a history of self harm and a habit of sucking her hair.
Discussion Trichobezoar is a mass of hair that accumulates within the stomach following ingestion as it is not affected by normal peristalsis. It is an uncommon and unusual diagnosis so the thought of it in children with vomiting and an abdominal mass may be neglected.