TRICHOBEZOAR OF JEJUNUM COMPLICATED BY ACUTE INTESTINAL OBSTRUCTION: A CLINICAL CASE.

BACKGROUND.  Independent trichobezoar of the jejunum, which causes acute obstruction, is extremely rare. The localization features of such a trichobezoar affect the diagnostic methods used, with a departure from the traditionally used algorithms and surgical tactics.

CLINICAL CASE DESCRIPTION.  A 12-year-old patient was admitted to the pediatric surgery department with abdominal pain and repeated vomiting. In clinical blood analysis, leukocytosis with neutrophil shift. Ultrasound examination of the abdominal organs revealed dilated intestinal loops with sluggish peristalsis and liquid contents.  Contrast X-rays of the abdominal cavity show signs of intestinal obstruction. With a preliminary diagnosis of acute intestinal obstruction, the patient was taken for diagnostic laparoscopy. At a distance of 100 cm from the ileocecal angle, a foreign body was found encircling the intestinal lumen, the proximal loops are dilated, hyperemic. To remove the foreign body, a minilaparotomy approach was performed, a loop of the small intestine was extracted into the wound, and a foreign body (trichobezoar) was extracted by longitudinal enterotomy. In the postoperative period, fibrogastroduodenoscopy revealed no signs of gastric trichobezoara. On the 17th day, the patient was discharged in a satisfactory condition.

CONCLUSION.  Migration of gastric trichobezoar into the jejunum with the development of acute small intestinal obstruction is a rare variant of the development of complications of trichobezoar. Our clinical case is atypical, given the patient's age, lack of medical history, and localization of trichobezoar, which influenced diagnostic and therapeutic tactics. However, such a clinical variant of trichobezoar is also possible, which should be taken into account in the diagnostic search in an urgent situation.