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IMAGES Table of Contents   
Year : 1999  |  Volume : 9  |  Issue : 3  |  Page : 137-139
Images - gastric trichobezoar


Department of Surgery, IG Medical College, Shimla, India

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Keywords: Bezoar, trichobezoar, stomach

How to cite this article:
Kaushik NK, Sharma YP, Negi A, Jaswal A. Images - gastric trichobezoar. Indian J Radiol Imaging 1999;9:137-9

How to cite this URL:
Kaushik NK, Sharma YP, Negi A, Jaswal A. Images - gastric trichobezoar. Indian J Radiol Imaging [serial online] 1999 [cited 2019 Jul 22];9:137-9. Available from: http://www.ijri.org/text.asp?1999/9/3/137/28320
Bezoars, the rare conglomerate masses of foreign material or indigestible organic substances, are found in the lumen of the gastrointestinal (GI) tract of man and other animals. Though most of the gastric bezoars occur as a complication of gastric or ulcer surgery, gastric bezoars may also be seen in the normal stomach as a result of ingestion of various objects which do not pass through the pylorus such as hair, prune pits, plastic, paper, string or cotton. Trichobezoars are formed from hair, either of the patient, other humans or animals and are an occupational hazard in brushmakers, blanket weavers and wool workers [1].


   Clinical Presentation Top


Eighty percent of bezoars occur before the age of 30 years and more than 90% occur in women [1]. Trichobezoars are comparatively rare in children, whereas lactobezoars have become more common in infants. An underlying psychological disturbance is common and a history of trichophagy or trichotillomania can occasionally be elicited [2].

The clinical manifestations depend on the location of the bezoar. Gastric bezoars may cause dyspepsia, nausea and vomiting (64%), colicky abdominal pain (70%), alteration of bowel habits (32%) and anorexia, weakness and weight loss [2]. In addition to the vague abdominal discomfort, bezoars may be associated with gastric outlet obstruction, ulceration and perforation. Distal extension of the bezoar can lead to obstructive jaundice, acute pancreatitis, protein-losing enteropathy, steatorrhea, mechanical small bowel obstruction alone or with perforation and the Rapunzel syndrome.

Clinical examination may reveal alopecia and halitosis due to decomposition and fermentation of fats trapped in the interstices of the bezoar. A well-defined smooth, firm, mobile epigastric mass is found in 88% of patients and there may be tenderness in 70% of patients [2].


   Discussion Top


The majority of the gastric bezoars are preoperatively diagnosed or confirmed on upper GI barium study. However Stelzner is believed to have been the first to record a correct preoperative diagnosis on the basis of physical examination in 1896 [3]. The upper part of a large bezoar may be visible as a mass with a convex upper border projecting into the gastric air bubble. An erect abdominal radiograph and a supine radiograph may also show a prominent gastric outline with an intragastric mottled mass, outlined by gas in the distended stomach, mimicking a food-filled stomach.

With a small amount of barium the hair-ball gets coated and becomes visible. Filling up the stomach with barium demonstrates a mobile intraluminal filling defect of variable size, which may show extension into the duodenum [Figure - 1]. The positive density of the mass due to residual contrast medium may be seen on delayed films. The study should be continued till the contrast reaches the ileo-cecal region to look for any extension, dislodging or synchronism of the gastric bezoar.

US, the primary imaging modality for the evaluation of an upper abdominal mass in children, demonstrates a superficially located broad band of high amplitude echoes along the anterior wall of the mass with sharp, clean posterior acoustic shadowing [Figure - 2] [4]. This characteristic appearance persists irrespective of the angulation of the transducer, alteration of position of the patient and the administration of clear water. This can be attributed to multiple tiny interfaces between the smooth, compressed, compact mass and the entrapped air and food debris. This specific US appearance excludes the clinical possibility of a pancreatic pseudocyst, splenic or renal mass, non-calcified gastric tumor, gastric duplication cyst and gastric outlet obstruction. However a heavily calcified mass such as teratoma, neuroblastoma or impacted mass of feces may produce a similar US image. Plain abdominal radiographs and barium meal study are helpful in excluding these entities as well as confirming the diagnosis of a gastric trichobezoar. The sharp, clean margins of the acoustic shadow rule out the possibility of gas and good which produce "dirty" shadowing.

Plain abdominal CT usually shows a mobile intragastric mass consisting of "compressed concentric rings", with a mixed density pattern due to the presence of entrapped air and food debris. Often small collections of barium from a previous upper GI barium study may be interspersed within the mass [Figure - 3] [5]. The demonstration of a normal gastric wall and the free mobility of the mass on rescanning, after alteration of the patient's position and administration of oral contrast, rule out origin from the gastric wall [Figure - 4].

 
   References Top

1.De Backey M, Ochsner A. Bezoars and concretions. Surgery. 1939; 5: 132-160.   Back to cited text no. 1    
2.De Backey M, Ochsner A. Bezoars and concretions. Surgery. 1938; 4: 934-963.   Back to cited text no. 2    
3.Stelzner, Haargeschwulst in Magen. Chirugenkongr, Zentralbl. Chir 1896; 3: 121.   Back to cited text no. 3    
4.Mc Cracken S, Jongeward R, Silver TM, Jafri SZH. Gastric trichobezoar: sonographic findings. Radiology 1986; 161: 123-124.   Back to cited text no. 4    
5.Newman B, Girdany BR. Gastric trichobezoars: sonographic and computed tomographic appearance. Pediatric Radiology 1990; 20: 526-527  Back to cited text no. 5  [PUBMED]  

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Correspondence Address:
Yash P Sharma
C/o Lakhanpal Medical Store, Boileauganj, Shimla (H.P) 171 005
India
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Source of Support: None, Conflict of Interest: None


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    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]

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