Trichobezoar Causing Airway Compromise during Esophagogastroduodenoscopy

Abstract

Objectives. (1) Report the case of a 5-year-old female with trichotillomania and trichophagia that suffered airway compromise during esophagogastroduodenoscopy for removal of a trichobezoar. (2) Provide management recommendations for an unusual foreign body causing extubation and partial airway obstruction. Methods. Case report of a rare situation of airway compromise caused by a trichobezoar. Results. A 5-year-old patient underwent endoscopic retrieval of a gastric trichobezoar (hairball) by the gastroenterology service under general endotracheal anesthesia in a sedation unit. During removal, the hairball, due to its large size, dislodged the endotracheal tube, effectively extubating the patient. The bezoar became lodged at the cricopharyngeus muscle. Attempts to remove the bezoar or reintubation were unsuccessful. The child was able to be mask ventilated while the otolaryngology service was called. Direct laryngoscopy revealed a hairball partially obstructing the view of the glottis from its position in the postcricoid area. The hairball, still entrapped in the snare from the esophagoscope, was grasped with Magill forceps and slowly extracted. The patient was then reintubated and the airway and esophagus were reevaluated. Conclusions. Trichobezoar is an uncommon cause of airway foreign body. Careful attention to airway management during these and similar foreign body extractions can prevent inadvertent extubations.

Uncommon cause of respiratory failure due to a bezoar in the hypopharynx: a case report

“…In a study conducted in trichobezoar patients between 18 and 26 years old, female to male ratio was achieved 4:1 and 15:1 in younger adults and older patients, respectively [5]. Clinically, trichobezoar patients present gastrointestinal disorders as the main complications [6]. Literature review showed that trichobezoars were seen in some rare cases, including (a) a 5-year-old female with trichotillomania and trichophagia with increased airway resistance as a primary component of laryngeal collapse [6], (b) a 51-yearold female with unusual dyspnea and T-tube obstruction [7], and (c) some cases in cats with an acute onset of dyspnea without or with prior clinical signs of esophageal disease and esophageal trichobezoars [8].…”

“…Clinically, trichobezoar patients present gastrointestinal disorders as the main complications [6]. Literature review showed that trichobezoars were seen in some rare cases, including (a) a 5-year-old female with trichotillomania and trichophagia with increased airway resistance as a primary component of laryngeal collapse [6], (b) a 51-yearold female with unusual dyspnea and T-tube obstruction [7], and (c) some cases in cats with an acute onset of dyspnea without or with prior clinical signs of esophageal disease and esophageal trichobezoars [8]. Esophageal foreign bodies with pure acute dyspnea have been also reported in the literature [9].…”

Two Cases of Hair Balls in Girls

“…При своевременной диагностике возможно эндоскопическое удаление небольших трихобезоаров [15]. Однако такие случаи в практике детских эндоскопи-стов встречаются нечасто, потому что волосяные опухоли малых размеров чаще всего оказываются случайной находкой при обследовании по другим причинам [16].…”

Human and Doll's Hair in a Gastric Trichobezoar, Endoscopic Retrieval Hazards

“…The trichobezoar's weight may exert pressure on the mucosa, exerting a mechanical effect, which may lead to ischemia. The lesser curvature of the stomach is more vulnerable to perforation as Data from (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”