JPGN Reports · 9 authors, 3 centres
This summary was generated by AI from a single paper. It has not been reviewed by a clinician and is not clinical advice. Verify against the source before acting on it.
This case report describes the first-ever documented instance of a giant colonic trichobezoar causing near-total large bowel obstruction in a 13-year-old girl with trichotillomania. The obstruction was successfully managed using a combined laparoscopic and endoscopic approach, avoiding the need for open surgery. This minimally invasive technique proved feasible and effective, highlighting its potential as a treatment option for similar rare cases.
**Background:** Bezoars are accumulations of undigested material in the gastrointestinal tract, with trichobezoars (hair) typically occurring in young girls with psychiatric disturbances like trichotillomania. While gastric trichobezoars are common, colonic trichobezoars causing obstruction are extremely rare. This case presents a 13-year-old girl with a giant colonic trichobezoar causing near-total obstruction, managed laparo-endoscopically.
**Methods:** A 13-year-old girl presented with abdominal pain, distention, vomiting, and 7 days of constipation. Initial abdominal X-ray showed air-fluid levels and colonic gas distension; ultrasound was normal. Conservative treatment (nasogastric tube, fluids, rectal irrigations) failed over 5 days. Diagnostic laparoscopy with three 5mm trocars revealed a markedly distended ileum and colon up to the rectosigmoid junction with a caliber leap. Colonoscopy identified a giant trichobezoar at the rectosigmoid junction. Endoscopic extraction was performed using a standard polypectomy snare and profuse colonic washout. Luminal integrity was confirmed via rectosigmoidoscopy.
**Key Results:** The procedure was successful with complete removal of the trichobezoar. The patient recovered well and was discharged the day after the procedure with a neuropsychiatric referral. No complications were reported. This is the first reported case of endoscopic extraction of a colonic trichobezoar in a pediatric patient.
**Clinical Implications:** Laparo-endoscopic management is feasible and effective for colonic trichobezoars, offering reduced trauma, faster recovery, fewer complications, and lower cost compared to conventional laparotomy. Psychological referral and follow-up are mandatory to prevent recurrence. This approach should be considered in similar rare cases.