Management of Trichobezoar in Gastrointestinal Disorders

Trichobezoars are compact conglomerations of ingested hair within the gastrointestinal lumen, most frequently arising in the stomach and occasionally extending into the small intestine. Management requires a multidisciplinary strategy integrating accurate diagnosis, definitive removal and prevention of recurrence. Clinical suspicion is raised by characteristic presentations of abdominal pain, palpable mass, gastric outlet obstruction and nutritional deficits such as iron deficiency anaemia. Imaging modalities—chiefly ultrasound, computed tomography and endoscopy—are pivotal for delineating extent and guiding therapy. Endoscopic retrieval is appropriate for small or early trichobezoars, but larger masses often necessitate surgical extraction. Open laparotomy has high success rates, while minimally invasive approaches, including laparoscopic removal and laparoscopic-assisted minilaparotomy, are gaining favour for selected patients. Crucially, long-term psychiatric assessment and behavioural therapy are integral to reducing self-hair-eating behaviours and preventing recurrence.

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Technical terms

Trichobezoar: A dense aggregate of ingested hair accumulating in the gastrointestinal tract, resistant to digestion and often forming a gastric mass.

Rapunzel syndrome: A rare variant of trichobezoar in which the hair mass extends beyond the stomach into the small intestine, sometimes causing obstruction.

Laparoscopic-assisted minilaparotomy: A hybrid surgical approach combining laparoscopic visualisation with a small abdominal incision to facilitate safe extraction of large bezoars.

References

1. Rapunzel syndrome: an infrequent cause of severe iron deficiency anemia and abdominal pain presenting to the pediatric emergency department. BMC Pediatrics (2018).
2. Large gastric trichobezoar causing failure to thrive and iron deficiency anaemia in an adolescent girl: a case report emphasising the imaging findings and review of the literature. BJR|case reports (2019).
3. Rapunzel Syndrome—An Extremely Rare Cause of Digestive Symptoms in Children: A Case Report and a Review of the Literature. Frontiers in Pediatrics (2021).
4. Gastric Perforation With Peritonitis Secondary to a Trichobezoar: A Literature Review and Report of a Rare Presentation. Cureus (2022).
5. Best management modality of trichobezoar: A case report. International Journal of Surgery Case Reports (2018).
6. Gastrointestinal trichobezoars in the pediatric population: a retrospective study. BMC Pediatrics (2024).
7. Acute Presentation of Rapunzel Syndrome and a Review of Bezoars. Cureus (2021).