Ulus Travma Acil Cerrahi Derg. 2023; 29(11): 1288-1295 | DOI: 10.14744/tjtes.2023.08434

A rare cause of intestinal obstruction in children trichobezoar: How to diagnose?

Meltem Kaba¹, Çetin Ali Karadað¹, Nihat Sever¹, Ýlayda Ser¹, Mesut Demir¹, Abdullah Yýldýz¹, Ayþe Merve Usta^2
1Department of Pediatric Surgery, Þiþli Hamidiye Etfal Training and Research Hospital, Ýstanbul-Türkiye
²Department of Pediatric Gastroenterology, Þiþli Hamidiye Etfal Training and Research Hospital, Ýstanbul-Türkiye

BACKGROUND: Trichobezoar is a rare clinical condition in children, which is caused by the accumulation of swallowed hair mass in the digestive tract. This condition is most common in young women with psychiatric histories who suffer from trichotillomania (TTM), where they have an irresistible urge to pull out their hair. Diagnosis and treatment of this pathology, which is already extremely rare, and its variable clinical presentations are challenging. The aim of this study was to increase awareness of trichobezoar in the differential diagnosis of signs of intestinal obstruction in children and to evaluate the diagnosis and management of this rare pathology.
METHODS: The clinical data of six patients who were treated for trichobezoars in the pediatric surgery department of our hospital between 2009 and 2022 were retrospectively analyzed.
RESULTS: Six female patients were treated with the diagnosis of trichobezoar during this period. Patients were diagnosed with the help of anamnesis, physical examination, abdominal ultrasonography (USG), and finally, endoscopy. USG can predict the intestinal wall infiltration and the tail extended to the duodenum through pylorus in the series. All patients were evaluated with contrast-enhanced abdominal radiography. Five surgical interventions were performed in four of the cases. In a case who underwent surgery twice, the distal intestinal satellite bezoar was not noticed in the first operation. Two patients were diagnosed to have trichobezoar, but surgery was not required. These patients were younger and had early-onset TTM (before 10 years old). The patients were followed for an average of 10.8 years and no recurrence was detected.
CONCLUSION: Trichobezoar is a rare cause of intestinal obstruction in children with fatal complications when diagnosed late. Failure to follow an algorithm for the management of the disease causes difficulties in the diagnosis and treatment. Especially in pa-tients with a known psychiatric history, whole abdominal USG and laparoscopy performed with awareness can prevent unnecessary examinations.

Keywords: Laparoscopy, pediatric surgery, trichobezoar, ultrasonography.

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Çocuklarda nadir bir intestinal týkanýklýk nedeni Trikobezoar: nasýl taný koyalým?

Meltem Kaba¹, Çetin Ali Karadað¹, Nihat Sever¹, Ýlayda Ser¹, Mesut Demir¹, Abdullah Yýldýz¹, Ayþe Merve Usta^2
1Þiþli Hamidiye Etfal Eðitim ve Araþtýrma Hastanesi, Çocuk Cerrahisi Kliniði, Ýstanbul, Türkiye
²Þiþli Hamidiye Etfal Eðitim ve Araþtýrma Hastanesi, Çocuk Gastroenteroloji Kliniði, Ýstanbul, Türkiye

AMAÇ: Trikobezoar, yutulan kýl kütlesinin sindirim sisteminde birikmesiyle oluþan, çocuklarda nadir görülen bir klinik durumdur. Bu durum, saçlarýný yolmak için karþý konulamaz bir dürtüye sahip olan Trichotillomania'dan (TTM) muzdarip, psikiyatrik geçmiþleri olan genç kadýnlarda görülür. Ol-dukça nadir görülen ve deðiþken klinik tablolarý olan bu patolojinin taný ve tedavisi zordur. Bu çalýþmanýn amacý, çocuklarda intestinal obstrüksiyon bulgularýnýn ayýrýcý tanýsýnda trikobezoar farkýndalýðýný artýrmak ve bu nadir patolojinin taný ve tedavisini deðerlendirmektir.
GEREÇ VE YÖNTEM: 2009-2022 yýllarý arasýnda hastanemiz çocuk cerrahisi kliniðinde trikobezoar nedeniyle tedavi edilen hastalarýn verileri ret-rospektif olarak incelendi.
BULGULAR: Kliniðimizde bu süreçte 6 kýz hasta Trikobezoar tanýsý ile tedavi edildi. Hastalar,anamnez, fizik muayene, batýn ultrasonografisi (USG) ve son olarak endoskopi yardýmý ile taný aldý. USG, mide duvarý infiltrasyonu olmadýðýný ve heterojen lezyonun pilor yolu ile duodenuma devamlýlýðýný gösterebildi. Tüm hastalar kontrastlý batýn grafisi ile deðerlendirildi. Olgularýn dördüne beþ cerrahi giriþim uygulandý. Ýki kez ameliyat edilen bir olguda ilk ameliyatta distal intestinal satellit bezoar fark edilemedi. Ýki hastada trikobezoar saptandý ancak cerrahi gerekmedi. Bu hastalar daha gençti ve erken baþlangýçlý TTM'ye sahipti (10 yaþýndan önce). Hastalar ortalama 10,8 yýl takip edildi ve nüks saptanmadý.
SONUÇ: Trikobezoar çocuklarda intestinal týkanýklýðýn nadir fakat geç taný aldýðýnda ölümcül komplikasyonlar yaratabilen bir sebebidir. Hastalýðýn yönetimi için bir algoritma izlenmemesi taný ve tedavi aþamasýnda zorluklara neden olmaktadýr. Özellikle psikiyatrik hikayesi bilinen hastalarda farkýn-dalýkla yapýlmýþ tüm batýn USG ve laparaskopi gereksiz tetkiklerin önüne geçebilir.

Anahtar Kelimeler: Çocuk cerrahisi, laparaskopi, trikobezoar, ultrasonografi.

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