·         Collections of indigestible material found in the gastrointestinal tract, usually the stomach

o       From the Persian word “padzahr” which means antidote since they were once used for this purpose

·         Incidence is very low

·         Risk of trichobezoar (eating of hair) is greater among mentally retarded or emotionally disturbed children

o       Also occurs as an occupational disease in brushmakers, blanket weavers and wool workers

·         Much more common in females (90%) aged 10 to 19

·         Etiology

o       Chewing on or eating hair or fuzzy materials or indigestible vegetable fiber

o       Material unable to exit stomach because of large size

o       Gastric outlet obstruction may play a roll

o       Poor gastric motility such as might occur in diabetics

·         Predisposition

o       Previous gastric surgery such as vagotomy, pyloroplasty, antrectomy or partial gastrectomy

o       Inadequate chewing of food

§         Missing teeth, dentures

o       Massive overindulgence of food with high fiber contents such as dates or persimmons

·         Clinical symptoms

o       Anorexia

o       Bloating

o       Early satiety

o       History of trichophagy – eating hair

o       Trichoptysis – hair may be coughed up

o       May be asymptomatic

·         Phytobezoar (55% of all bezoars):

o       Poorly digested vegetable fibers such as

§         Skin and seeds of fruits and vegetables

·         Oranges

·         Persimmons

o       Most common

o       Unripe persimmons contain a chemical “shibuol” that forms a glue-like coagulum after contact with dilute acid in the stomach

o       May become impacted in small bowel after forming in stomach

·         Trichobezoar (hair)

o       80% are < age 30, almost exclusively in females

o       Associated with gastric ulcer in 24-70%

·         Radiographic findings

o       Upper part of a large bezoar may be visible as a mass with a convex upper border projecting into the gastric air bubble

o       An erect abdominal radiograph and a supine radiograph may show a prominent gastric outline with an intragastric mottled mass, outlined by gas in the distended stomach, mimicking a food-filled stomach

o       On barium studies, they produce an intraluminal filling defect without attachment to bowel wall

o       Interstices of bezoar are filled with barium

 

A trichobezoar in a mentally disturbed 14 year-old girl who was eating her own hair.
Note the large filling defect occupying most of the stomach
with barium mixed in within the interstices of the mass.
A delayed film would show the barium remaining in the bezoar while exiting the rest of the stomach

 

 

o       Barium remains in bezoar for hours after exiting remainder of bowel

§         Get delayed film if bezoar is suspected

o       Partial or  complete bowel obstruction

o       CT

§         Mobile intragastric mass consisting of "compressed concentric rings"

§         A mixed density pattern due to the presence of entrapped air and food debris

·         Complications

o       Pressure necrosis of bowel wall may lead to perforation, peritonitis

o       Distal extension of the bezoar can lead to

§         Obstructive jaundice

§         Acute pancreatitis

§         Protein-losing enteropathy

§         Steatorrhea

§         Mechanical small bowel obstruction alone or with perforation

·         DDx

o       Lobulated, villous adenoma

o       Leiomyosarcoma

 

For a photo of a trichobezoar (not the one in the patient on this page), go to the following link at the National Museum of Health and Medicine: http://nmhm.washingtondc.museum/explore/anatifacts/4_trich.html