Gastric Trichobezoar Mimicking a Large Abdominal Tumour: Case report

Bilal Imširović, G. Abdelhakim, Muhamed Djedovic, Amina Tawil, E. Zerem
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Abstract

Background: A bezoar is a collection of indigestible substances that, after swallowing, form a mass in the gastrointestinal tract, most often in the stomach. A trichobezoar is a mass made of ingested, undigested hairs and food remains, while ingestion of hair is called trichophagia. This is an extremely rare condition, with 90% of cases occurring among women, out of which 80% are under the age of 30. The diagnosis is based on clinical examination, findings obtained through radiological modalities (ultrasound and computed tomography) and endoscopy. Objective: The aim of this article is to present the case of a 17-year-old female patient who visited the doctor due to abdominal pain and a visible mass in the projection of the stomach. Case presentation: The patient, accompanied by her parents, and following the instructions of a general practitioner who suspected the presence of a tumour in the abdomen, reported to the surgical clinic. The US examination revealed the presence of a heteroechoic mass in the stomach area, but it could not be determined with certainty where it belonged (Samsung Medison V8 ultrasound system). The CT scans revealed the presence of an inhomogeneous structure in the stomach area occupying the entire volume of the stomach. The mentioned structure included the presence of internal air particles and marginal imbibition of the orally applied contrast agent. The described structure did not infiltrate the stomach wall and, based on the CT scan, the diagnosis established was a bezoar. Under general anaesthesia, a laparotomy with a gastrotomy was performed, and a hard hook shaped mass composed of hair and remains of undigested food was removed from the stomach. Conclusion: A mobile, palpable mass located in the abdomen of younger female patients accompanied by abdominal symptoms, especially in patients where there is information about hair pulling and swallowing, may suggest trichobezoar. The golden standard for trichobezoar presentation is upper endoscopy. If unavailable, the diagnosis is established by a CT scan, preferably with oral application of a contrast agent. Treatment of larger trichobezoars is surgical, while endoscopic and laparoscopic removal is possible only in the case of small trichobezoars.
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模拟腹部大肿瘤的胃毛癣1例
背景:牛黄是一种不可消化物质的集合,吞咽后在胃肠道中形成肿块,最常见于胃。毛虫是由摄入的、未消化的头发和食物残渣组成的团块,而摄入头发被称为食毛症。这是一种极其罕见的情况,90%的病例发生在女性中,其中80%的患者年龄在30岁以下。诊断是基于临床检查,通过放射模式(超声和计算机断层扫描)和内窥镜检查获得的结果。目的:这篇文章的目的是提出一个17岁的女病人谁去看医生由于腹痛和可见的肿块在胃的投影。病例介绍:患者在父母的陪同下,在一位怀疑腹部有肿瘤的全科医生的指导下,到外科诊所就诊。美国检查显示胃区有一个异回声肿块,但不能确定它属于哪里(三星麦迪森V8超声系统)。CT扫描显示胃区存在不均匀结构,占据整个胃的体积。所述结构包括内部空气颗粒的存在和口服造影剂的边际吸吮。所描述的结构没有浸润胃壁,根据CT扫描,诊断为牛黄。在全身麻醉下,进行剖腹手术和胃切除术,从胃中取出由头发和未消化食物残渣组成的硬钩状肿块。结论:伴有腹部症状的年轻女性患者腹部可移动、可触及的肿块,特别是有拔毛和吞咽信息的患者,可能提示有毛粪。毛粪表现的黄金标准是上内窥镜检查。如果无法获得,则通过CT扫描确定诊断,最好是口服造影剂。较大的毛滴虫的治疗是手术,而内窥镜和腹腔镜切除只可能在小毛滴虫的情况下。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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