Gastric trichobezoar

The term bezoar was derived from the Persian word 'panzeh' meaning 'antidote'. In ancient times, bezoars were considered as a protection against poisoning. They are divided into three categories according to components; phytobezoars (plant material), trichobezoars (hair) and lactobezoars (milk). Phytobezoars are generally found in patients with history of gastric surgery. Lactobezoars are exclusively found in infants. Prematurity and concentrated formulas are leading causes of lactobezoars. Trichobezoars are caused by ingestion of high amount of hair over many years. They are formed typically in stomach and they may enlarge leading to gastric outlet obstruction. The cause of hair ingestion may be associated with mental retardation, pica or trichotillomania which is a behavioural disturbance characterized by the compulsive urge to pull one's hair and eat it. Up to 90% of all trichobezoars occur in girls younger than 20 years old . Males are rarely affected. Trichobezoar have a special type called 'Rapunzel Syndrome'. In that syndrome gastric trichobezoars could have a long tail that can extent to ileoceal valve.Common presenting symptoms are abdominal pain, nausea, vomiting, weight loss, malnutrition, hematemesis, diarrhoea or constipation. On physical examination epigastric mass may be palpated. Alopecia may also be present due to trichotillomania.