A trichobezoar in the jejunum complicated by the acute intestinal obstruction: a clinical case

An independent trichobezoar in the jejunum, which causes the acute obstruction, is an extremely rare case. A specific location, like that in the discussed case, influences the diagnostic process and surgical tactics, when one has to stay away from the traditionally used algorithms.

A 12-year-old patient was admitted to the pediatric surgical department with abdominal pain and repeated vomiting. In the clinical blood analysis, leukocytosis with neutrophil shift was registered. Ultrasound examination of the abdominal organs revealed dilated intestinal loops with sluggish peristalsis and liquid contents. Contrast X-rays of the abdominal cavity showed signs of intestinal obstruction. With preliminary diagnosis of acute intestinal obstruction, the patient was taken to the diagnostic laparoscopy. A foreign body was found at 100 cm distance from the ileocecal angle which obturated the intestinal lumen; proximal loops were dilated, hyperemic. To remove the foreign body with minilaparotomic approach, a loop of the small intestine was pulled into the wound, and a foreign body (trichobezoar) was removed by longitudinal enterotomy. At the postoperative period, fibrogastroduodenoscopy revealed no signs of gastric trichobezoar. On day 17, the patient was discharged in a satisfactory condition. She was given recommendations for further outpatient regime; psychiatrist’s consultation was also recommended to her.

Migration of a gastric trichobezoar into the jejunum complicated with acute small intestinal obstruction is a rare situation. Our clinical case is atypical one, given the patient’s age, lack of medical history, and trichobezoar location, which influenced diagnostic and therapeutic tactics. However, such a clinical picture of trichobezoar is also possible, and this case has to aware medical specialists in the diagnostic search of patients in urgent state.