Braids in the Belly: A Case Report of Retrieving Gastric Bezoar Through Endoscopy

Inroduction: Trichotillomania is a chronic hair-pulling disorder resulting in hair loss that impacts 0.6% to 3.6% of adults. 5-18% of these patients can ingest the hair and can rarely form trichobezoars over time to cause gastrointestinal injury. We present here a rare, but clinically significant, case of a trichobezoar that caused our patient gastrointestinal harm. Case Description: Our patient is a 26 year old woman with past medical history of Erb's palsy, Intellectual Disability, and Autism who was scheduled for bidirectional endoscopic evaluation for constipation of 4 months with 4 days of liquid diet followed by polyethylene glycol. EGD showed the gastric body full of braided hair and the scope was unable to be advanced past the body, and the hair was unable to be removed, as she was difficult to sedate properly. Colonoscopy showed two thick hair braids that were removed. A repeat EGD under general anesthesia showed 43 hair braids inside the stomach that were difficult to remove, even with rat tooth forceps. The esophagus was inflamed and edematous. She was hair free after the procedure. The pathology returned braided hair or filamentous accessory measuring up to 46cm long and 0.6cm wide. She remained intubated post EGD due to esophageal bleeding. The Hgb stayed at her baseline of 14. A CT Abdomen after showed no signs of obstruction or foreign body. She was discharged with close psychiatry follow up. Discussion: As trichobezoars are rare in their diagnosis, they can often go unnoticed for long periods of time, which can be serious in their complications such as: obstructive jaundice, intestinal bleeding, bowel obstructions, or even perforation. Trichotillomania occurs with underlying psychiatric disorders, and as in our case, in developmental delay, which also compounds the difficulty of a trichobezoar's diagnosis given the difficulty in physical exam and accurate history in such patients. Hence, this case helps describe the importance to raise the index of suspicion for this disease, and the importance of a multidisciplinary approach with the patient's primary care giver and psychiatrist to help diagnose this as soon as possible and prevent this problem and its possible reoccurrence.1883_A Figure 1. Hair braid being retrieved1883_B Figure 2. Hair braids post procedure