The giant in the stomach – trichobezoar

Bezoar is an uncommon phenomenon which results from the accumulation of ingested foreign material such as hair, fur or fiber which can easily lead to formation of a large mass in the intestinal tract [1]. Bezoars were once prized as magical items with protective properties. The word “bezoar” comes from the Persian for “protection from poison”. People would place bezoars in their drinking glasses as an antidote to any potential poisons, and even set them into jewelry. There was a gold-framed bezoar in the Crown Jewels of Queen Elizabeth I as recently as 1962.

During diagnostic gastrointestinal endoscopy it can be found in less than 1% of all patients complaining about nonspecific abdominal symptoms [2]. The first case was reported in the literature by Baudomant in 1779 [3] and the first surgical removal was performed in 1883 by Schonbern [3]. Depending on what it is made of we can distinguish different bezoars. The major types are phytobezoars (composed of vegetable fibers), trichobezoars (hair, fur), and pharmacobezoars (drugs). Medications reported to cause bezoars include aluminum hydroxide gel, enteric-coated aspirin, sucralfate, guar gum, cholestyramine, enteral feeding formulas, psyllium preparations, nifedipine, and meprobamate [4].

The structure grows because of continuous supply of food rich in cellulose, matted together by protein, mucus and pectin. Bezoars are rare in healthy people. It is believed that any previous operations or gastric dysfunction can lead to formation of a new mass. More recent studies have shown that 70% to 94% of patients with bezoars have a history of gastric surgery and 54% to 80% have undergone vagotomy, pyloroplasty, subtotal distal gastrectomy or antrectomy [5]. It is also statistically significant for patients with impaired gastric emptying to have a higher chance of getting a bezoar. Diabetics with autonomic neuropathy are also at risk.

Trichotillomania (repeated action of pulling the hair for pleasure or decreasing tension) and trichophagia lead to formation of a trichobezoar in the stomach. Trichotillomania is considered as a psychiatric state caused by the bad perception that one has about one’s own hair, negative emotional experiences (tension, loneliness, fatigue) and recently identified factors such as studying, reading, and watching television [3]. The Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (DSM-IV) classifies it as...


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