Cystic intestinal pneumatosis in the context of gastric trichobezoar

Leandro Jaime Barreto Costa, Mário Gissoni de Carvalho, Ana Paula Nogueira Machado, Marcelo Fagundes Rocha

Abdominal pain, gastrointestinal, laparotomy, obstruction, perforation trichotillomania, trichophagia

As the name implies, the trichobezoar is a consolidation of hair, which, due to its structural properties, it is resistant to digestive enzymes and accumulates in the folds of the gastric mucosa, impacting with food remains and mucus. The starting frame is usually nonspecific and late, patients may remain asymptomatic for several years. Thus, the initial manifestations can range from symptoms common symptoms, such as epigastric discomfort, abdominal pain, nausea and vomiting, to severe cases of malnutrition and anemia due to ulceration of the gastric mucosa or abdomen acute, by intestinal occlusion or viscera perforation. The objective examination highlights in 80% of patients a palpable abdominal mass, typically epigastric, but without distinctive features on palpation, which makes it difficult to differentiate between a possible hepatomegaly or chorda colic, as initially seen in this patient. Halitosis or alopecia can coexist, which often go unnoticed, and require a more detailed anamnesis and subsequent investigation. Because of this presentation, the diagnosis can become difficult, as verified in the clinical case exposed, which eluded the initial clinical and imaging evaluation.

10.22161/ijaers.4.12.32