By Dr.

Sanjeevanee Kelkar

She is a general surgeon & for last 16 years has been working as a full time
General Surgeon in a Charitable Trust Hospital in Nagpur. She is also a Senior
Consultant & has been the Medical Superintendent also for last 5 years. 
• Trichobezoar extending from Stomach till terminal Ileum.
• “Trichotillomania”
• Trichobezoar is a rare clinical condition.
• Stomach is the common site of occurance.
• Intestinal obstruction due to trichobezoar is extremely rare.
• Tricho=hair ,Bezoar=mass or ball.
• Adolescent girls - 90%
• H/O swallowing hair,,eating hair is found in 1:2000 children.
• 10% patients show psychiatric abnormalities or mental retardation.
• First case of human trichobezoar was reported by Baudamant in1779.
 Problem-Stomach not able to exteriorize
hair & other substances out of lumen
because the friction surface is not
sufficient for propulsion by peristalsis.
 Indigestible matter trapped by mucus in
stomach, forms shape of stomach
gradually .
 Age occurance----1year to 56 years
 Common age---15 to 20 years & 90%
girls
 Symptoms—Epigastric
pain,dyspepsia,postprandial fullness.
 Gastric bleeding—6%.
 Intestinal obstruction or perforation—
10%
 Iron def.anemia.
Investigations
 Proper history=suspicion.only
 Xray,only barium meal if done.
 Usg-high echogenicity of hair &
presence of multiple acoustic interfaces
created by trapped hair & food limits usg
diagnosis.
 Endoscopy.
 CT & MRI.
Ms. Poojabai Patel.(from Damoh M.P.)
 14 year old girl was admitted in CIIMS on 20th July
evening with acute colicky abdominal pain of 25
days duration.
 She was persistently vomiting and was restless
for 7 days.
 Her vitals were B.P.110/70mmhg,pulse
110/mt,pale dehydrated .
 Her xray standing abdomen revealed subacute
intestinal obstruction.
 She was managed conservatively,R.T,I/V fluids
Enemas, Duphalac ,responded by passing motion,
reduction in distention ,hence conservative
management was continued. On 3rd day she was
again the same ,hence decided to be taken for
exploratory laparotomy.
 Laparotomy –grossly distended small
bowel loops with multiple perforations
,adhesions ,intussusception—causing
intestinal obstruction.
 grossly dilated terminal ileum,in which
some funny cordlike thing was felt.
 perforations revealed
trichobezoar.Evacuated.
 Laparotomy –grossly distended small
bowel loops with multiple perforations
,adhesions ,intussusception—causing
intestinal obstruction.
 grossly dilated terminal ileum,in which
some funny cordlike thing was felt.

 perforations revealed trichobezoar.

Evacuated.
 Multiple mesenteric Lymph nodes
enlarged.
 Resection & anastomosis was done.
 Stomach was inspected & found huge
bezoar.
 Gastrotomy done and huge stomach –
shaped trchobezoar evacuated.
 Lavage, hemostasis,drainage & closure.
 Postoperatively first 48 hours was o.k./,
then bp started fluctuating ,shifted to
ICU,INR deranged,
 In spite of doing everything died after 72
hours, the pathetic ending .