Rare case of trichobezoar causing pancreatitis in a young woman

Abstract

This is a case of a 14-year-old woman diagnosed with acute pancreatitis based on history and laboratory investigations. CT scan confirmed the diagnosis of acute pancreatitis along with the presence of two bezoars in the stomach and proximal jejunum. Gastroscopy showed a large trichobezoar with difficult endoscopic extraction. Accordingly, the patient underwent laparotomy, gastrostomy and enterotomy with successful removal of the large gastric and jejunal daughter bezoars. Following surgery, pancreatitis resolved and investigations returned to normal. Child psychiatry consultation was sought, and she was diagnosed with trichotillomania and trichophagia.

Acute Pancreatitis due to Phytobezoar Case Report and Mini-Review of Literature

“…In the literature, there are a limited number of cases of acute pancreatitis induced by duodenal bezoars. When these cases are evaluated, it is seen that the age range is quite wide between 14-85 [9,10]. We think that this situation is consistent with the fact that the mechanisms that facilitate bezoar formation are different (due to psychological disorders such as trichobezoars, personal causes such as chewing disorders in the elderly, or geographical reasons such as persimmon consumption).…”

“…We think that this situation is consistent with the fact that the mechanisms that facilitate bezoar formation are different (due to psychological disorders such as trichobezoars, personal causes such as chewing disorders in the elderly, or geographical reasons such as persimmon consumption). In the literature review, it is understood that various invasive attempts (removal of the bezoar by laparotomy or endoscopic fragmentation and removal of bezoar) have been applied to all of the cases at the time of diagnosis or after medical treatment [9][10][11]. As in our case, only medical treatment will be sufficient for the treatment of pancreatitis in cases where obstruction disappears by moving forward of the bezoar spontaneously or perhaps by fragmentation of bezoar with the help of peristaltic movements.…”

Sindrom Rapunzel – rijedak uzrok akutnog pankreatitisa

“…Ultrazvukom abdomena prikazana je gušterača potisnuta tvorbom u želucu, a laboratorijskom analizom enzima gušterače uvidjela se povišena koncentracija istih u serumu te se tako potvrdila dijagnoza akutnog pankreatitisa. Djevojka je hospitalizirana na odjelu dječje gastroenterologije gdje je započeto liječenje prema protokolu za akutni pankreatitis i učinjena je dalja b 2,6 . CT abdomena koristan je zbog mogućnosti pregleda veličine tvorbe i njezine proširenosti kao u slučaju sindroma Rapunzel ili pak za prikaz lokacije multiplih trihobezoara.…”

“…U literaturi postoje podaci prema kojima su pacijenti operirani bez prethodnog liječenja pankreatitisa. U prilog ovom pristupu govori i činjenica da je do pada serumskih koncentracija gušteračinih enzima došlo već unutar 24 h od zahvata 6,7 . Nema jasnih podataka koji govore da je jedna opcija učinkovitija od druge.…”

Risk factors for critical care admission in acute pancreatitis

“…To this date no published research has addressed acute pancreatitis incidence, admissions, length of hospital stay or outcome in the Kingdom of Bahrain and only a few case reports of rare causes of acute pancreatitis are found in the English literature. [12][13][14][15] The main objective of this study was to analyze factors that may predict the need for critical care admission (CCA) in patients diagnosed with acute pancreatitis and to investigate differences in mortality and length of stay according to the level of CCA.…”