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A hairy situation: trichobezoar presenting with intussusception, and intestinal and biliary perforation in a child

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ABSTRACT

Trichobezoars are an uncommon cause of acute abdominal pain. We present a case of a 12-year-old girl with a history of a trichobezoar who presented to the emergency department with acute abdominal pain. Abdominal sonography was performed which suggested portal venous gas and showed complex peritoneal fluid. Subsequent computed tomography demonstrated both gastric and small bowel bezoars, with a jejunojejunal intussusception, and confirmed portal venous gas and complex ascites. At the time of surgery, there was evidence of intestinal and biliary perforation. Our case illustrates a constellation of complications in association with a long-standing trichobezoar.

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Related in: MedlinePlus

Transverse sonogram demonstrates a heterogeneous appearance of the liver with the presence of innumerable hyperechoic specks (arrows), suggestive of possible portal venous gas. Complex fluid collection was also noted (not shown).
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fig1: Transverse sonogram demonstrates a heterogeneous appearance of the liver with the presence of innumerable hyperechoic specks (arrows), suggestive of possible portal venous gas. Complex fluid collection was also noted (not shown).

Mentions: A 12-year-old girl presented to the emergency department with progressively worsening abdominal pain, emesis, and constipation, with a medical history significant for Turner mosaicism, trichophagia, and a large gastric bezoar diagnosed 5 months prior which was being treated conservatively. Physical examination findings were notable for tachycardia to 140, and a palpable large, midline epigastric mass. Her abdomen was distended with mild tenderness to palpation in the lower abdominal quadrants. No guarding or rigidity was noted. Abdominal sonography was performed which revealed portal venous gas (Fig. 1) and a large amount of complex peritoneal fluid. Contrast-enhanced computed tomography (CT) showed a large gastroduodenal bezoar and a proximal jejunal bezoar with a large jejunojejunal intussusception (Fig. 2).


A hairy situation: trichobezoar presenting with intussusception, and intestinal and biliary perforation in a child
Transverse sonogram demonstrates a heterogeneous appearance of the liver with the presence of innumerable hyperechoic specks (arrows), suggestive of possible portal venous gas. Complex fluid collection was also noted (not shown).
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5310247&req=5

fig1: Transverse sonogram demonstrates a heterogeneous appearance of the liver with the presence of innumerable hyperechoic specks (arrows), suggestive of possible portal venous gas. Complex fluid collection was also noted (not shown).
Mentions: A 12-year-old girl presented to the emergency department with progressively worsening abdominal pain, emesis, and constipation, with a medical history significant for Turner mosaicism, trichophagia, and a large gastric bezoar diagnosed 5 months prior which was being treated conservatively. Physical examination findings were notable for tachycardia to 140, and a palpable large, midline epigastric mass. Her abdomen was distended with mild tenderness to palpation in the lower abdominal quadrants. No guarding or rigidity was noted. Abdominal sonography was performed which revealed portal venous gas (Fig. 1) and a large amount of complex peritoneal fluid. Contrast-enhanced computed tomography (CT) showed a large gastroduodenal bezoar and a proximal jejunal bezoar with a large jejunojejunal intussusception (Fig. 2).

View Article: PubMed Central - PubMed

ABSTRACT

Trichobezoars are an uncommon cause of acute abdominal pain. We present a case of a 12-year-old girl with a history of a trichobezoar who presented to the emergency department with acute abdominal pain. Abdominal sonography was performed which suggested portal venous gas and showed complex peritoneal fluid. Subsequent computed tomography demonstrated both gastric and small bowel bezoars, with a jejunojejunal intussusception, and confirmed portal venous gas and complex ascites. At the time of surgery, there was evidence of intestinal and biliary perforation. Our case illustrates a constellation of complications in association with a long-standing trichobezoar.

No MeSH data available.


Related in: MedlinePlus