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A 13 year old adolescent girl presented with vague abdominal pain of a week’s duration. The pain was not associated with vomiting, fever, or weight loss. She was thin built and had mild pallor. Examination of the abdomen revealed a large curvilinear hard intra-abdominal mass, occupying the epigastric and left hypochondriac regions (fig 1). Abdominal skiagram and ultrasonography were suggestive of gastric bezoar. A history of pica and ingestion of hair strands was obtained subsequently. Laparotomy was performed and a huge trichobezoar was removed from the stomach in toto successfully (fig 2).
Bezoar is a concretion of material in the lumen of the digestive tract ingested over time.1 Four types of bezoar have been described: phytobezoar (vegetable material); trichobezoar (hair); lactobezoar; and miscellaneous. The presenting symptoms are abdominal pain, vomiting, early satiety, anorexia, weight loss, abdominal mass, and rarely gastric obstruction. Abdominal skiagram and upper gastrointestinal contrast study are diagnostic. Therapeutic options consist of endoscopic fragmentation and removal, and dissolution with substances such as papain, saline, acetylcysteine, and cellulase. Extracorporeal shock wave lithotripsy and laser therapy have been described as therapeutic modalities.2 Trichobezoars virtually always require surgical removal.3 They are often found in emotionally disturbed patients and warrant a psychiatric evaluation to prevent recurrence.2