Background

Trichobezoar is a rare condition that usually occurs in adolescents with psychic disorders [1]. It refers to the unusual presence of hair, as a solid mass, in the gastrointestinal tract. It is suspected on radiology and confirmed by oesogastroduodenal fibroscopy. The treatment is essentially surgical associated with psychological care [2].

We report a case of gastroduodenal trichobezoar collected in the department of Gastroenterology of the CHU Ibn Rochd of Casablanca, Morocco.

Patient and observation

This was a 17-year-old girl, known to be depressed but not followed up, who had been presenting for six months with diffuse abdominal pain and early postprandial food vomiting with no weight loss. On examination, the patient reported the notion of trichophagia and onychophagia since the age of 12 years.

The general examination revealed a pale, malnourished patient with several patches of frontal and temporal alopecia, discolored conjunctivae and foul breath. Abdominal examination revealed abdominal tenderness with a 10 cm long epigastric mass, hard, mobile and painful, extending to the umbilicus. The rest of the somatic examination was unremarkable.

Abdominal CT scan showed gastric and duodenal distension with heterogeneous contents of fluid, fat and aeriform density with enhancement and regular thickening of the gastric wall (Figure 1).

Figure 1: Abdominal CT scan in axial section showing a gastric trichobezoar

The oesogastroduodenal fibroscopy confirmed the presence of a voluminous intraluminal formation made of intertwined hairs occupying the whole stomach in connection with the trichobezoar (Figures 2 and 3)