Secretory diarrhea owing to a tape bezoar in a child with Hirschsprung’s disease

Nowicki, Michaeł; Miller, Richard C.

doi:10.1016/s0022-3468(03)00585-2

Cited by 3 publications

(1 citation statement)

References 12 publications

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“…The physical complications of trichotillomania include rash or infection on the scalp, repetitive stress injury, and carpal tunnel syndrome (19). When trichophagia is present, complications can also include gingivitis and, secondary to formation of a trichobezoar, gastrointestinal blockage and perforation or secretory diarrhea and malabsorption of nutrients, leading to vitamin deficiencies (10,19,20). While rare, the formation of trichobezoars is the most serious complication of trichotillomania.…”

Section: Complicationsmentioning

confidence: 99%

Hair Apparent: Rapunzel Syndrome

Frey¹,

McKee²,

King³

et al. 2005

AJP

109

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Emily (all names and identifiers have been changed to protect confidentiality) was a 7-year-old girl seen by her pediatrician for a routine annual examination. Although Emily had voiced no complaints, her mother had noted that she had appeared paler than usual. Upon physical examination, her pediatrician noted a nontender palpable mass in the child's stomach, leading him to order an abdominal ultrasound. The study showed no evidence of any abnormalities, although the technician did note that Emily must have just eaten because her stomach was full. However, her mother reported that Emily had not eaten since breakfast, 4 hours earlier.On reevaluation the next day, Emily's pediatrician still palpated the same mass, leading him to order a computed tomography (CT) scan of the abdomen. The abdominal CT demonstrated a free-floating mass that filled the entire stomach and was surrounded by a thin rim of contrast material (Figure 1). Emily's pediatrician did not think the mass was consistent with a neoplasm but was concerned that it could be a conglomeration of something she had ingested. Upon further questioning, Emily reported no stomach pain, nausea, vomiting, reflux, diarrhea, flatulence, recent illnesses, or fever. Her mother reported no change in her bowel habits and stated that Emily never wanted to eat much in one sitting.Given the large size and appearance of the mass on tomography, a decision was made to remove it surgically. Just as the elective surgery was scheduled, Emily was referred for evaluation by the child psychiatry consultation-liaison team. Initial Psychiatric ConsultationThe child psychiatry team (A.S.F. and A.M.) met with Emily and her mother the morning before surgery. By her own and her mother's account, she was happy and well adjusted. She had many friends and was enrolled in a mainstream public school second-grade class that she enjoyed.Emily lived in the home of a family friend with her mother (Kim), her older half sister, and her younger brother. Up until 2 years before, Emily had lived with her mother, siblings, and father in their own home. Kim felt that family life had been generally good during the marriage and that her husband had been a good father; Emily was especially close to him. Emily's father, however, had a substance abuse problem that led to dissolution of the marriage 2 years before admission. After this, the parents' relationship became strained, and Emily had not seen her father in a year.Emily was briefly in counseling to help her deal with the changes in her life surrounding her parents' separation, but the counselor felt that she was coping well and did not require further psychotherapy. Kim, however, expressed private concern that Emily was not dealing with the loss of her father. Meanwhile, Emily had started at a new school and was doing well academically and socially. With this background information, further evaluation was deferred until after the surgery, when the identity of the mass would be elucidated. Surgical ProcedureBecause the mass in Emily's stomach appeared ...

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Section: Complicationsmentioning

confidence: 99%