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An 8 year old girl with a severe language disorder and a background of fetal valproate syndrome presented with a three month history of abdominal pain, significant weight loss, and anorexia. Routine bloods and an abdominal ultrasound were normal. Upper gastrointestinal endoscopy revealed a mass of hair obstructing the pylorus with its extension into the duodenum (fig 1) necessitating surgical removal. A barium meal revealed a filling defect in the stomach (fig 2).
Trichotillomania (pulling at one's own hair) and trichophagia are closely related and can lead to a trichobezoar. They predominantly affect females in early childhood or adolescence.4,5 Our patient had developed a bald patch due to obsessive hair pulling. Trichobezoars cause abdominal symptoms, suchas postprandial fullness, intermittent vomiting, and abdominal pain. Surgery is indicated to relieve obstruction and pressure necrosis.6 A multidisciplinary approach should be adopted to prevent recurrence. In patients with learning difficulties and gastrointestinal symptoms a low threshold for upper gastrointestinal endoscopy should be maintained.
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