pica and Trichotillomania

Trichobezoar is a rare condition that occurs mostly in young women with psychiatric disorders such as trichotillomania and trichophagia. We report the case of a giant gastric trichobezoar in a 21-year-old woman who presented with chronic abdominal pain, vomiting and weight loss. Abdominal examination revealed a large epigastric mass. Endoscopic and imaging findings were highly suggestive of a gastric trichobezoar. Surgical extraction of the huge hair mass was successfully performed through an open gastrotomy. Postoperatively, history of a neglected chronic depression with suicidal ideation was diagnosed. Consequently, the patient was referred to the psychiatric department for mental healthcare, to prevent trichobezoar recurrences.

Topics: Bezoars; Depressive Disorder; Female; Gastroscopy; Humans; Laparotomy; Pica; Stomach; Tomography, X-Ray Computed; Trichotillomania; Young Adult

Rapunzel syndrome is a rare case of bowel obstruction resulting from hair ingestion (Trichobezoar). The obstruction can occur in any level of intestinal tract, but usually the stomach is primary involved. This syndrome is usually reported in patients affected by Trichotillomania or Pica syndrome, an obsessive-compulsive disorder that are characterized by an irresistible need to eat body hairs or non-digestible substances 1. When bowel obstruction occurs, it may be treated conservatively, but sometimes surgery is required. We reported two cases of Rapunzel Syndrome in two pediatric patients with different clinical presentation. Both patients were initially treated conservatively but eventually they underwent surgery. KEY WORDS: Bowel obstruction, Rapunzel syndrome, Trichobezoar.. La Sindrome di Raperonzolo è una rara causa di occlusione intestinale correlata alla presenza di un tricobezoar che si localizza a livello gastrico, il quale si estende anche a livello intestinale. I tricobezoar sono corpi estranei che si formano nell’apparato digerente a seguito dell’ingestione di capelli. È una patologia che si riscontra in particolar modo in pazienti affetti da disturbi psichiatrici quali la tricotillomania, disturbo ossessivo compulsivo in cui i pazienti tendono ad ingerire i propri capelli, e il picacismo, disturbo dell’alimentazione in cui i soggetti tendono a ingerire sostanze inorganiche-indigeribili. Il quadro occlusivo dovuto alla presenza di tricobezoar può essere trattato in modo conservativo, ma in casi gravi è necessario l’intervento chirurgico per la rimozione del corpo estraneo. In questo Case Report si discuterà della Sindrome di Raperonzolo e in particolare si discuterà di due casi clinici correlati a tale sindrome. I casi clinici riguardano due giovani pazienti con Sindrome di Raperonzolo, giunte alla nostra osservazione presentando quadri clinici diversi: un quadro di anemia sideropenica da malassorbimento e un quadro franco di occlusione intestinale da tricobezoar. Per gli scarsi risultati del trattamento conservativo, entrambe le pazienti sono state sottoposte ad intervento chirurgico di gastrotomia ed enterotomia in regime d’urgenza per la rimozione dei tricobezoar causanti i diversi quadri clinici.

Topics: Adolescent; Bezoars; Female; Humans; Pica; Stomach; Syndrome; Trichotillomania

Topics: Bezoars; Diagnosis, Differential; Female; Humans; Pica; Stomach; Stomach Neoplasms; Trichotillomania; Young Adult

We used a biobehavioral treatment consisting of melatonin and a standardized bed and wake time to decrease one girl's head and mouth touches associated with sleep-related trichotillomania and trichophagia. We remotely coached the girl's caregiver to implement all procedures and monitored response to treatment using a DropCam Pro video camera equipped with night-vision capabilities. Head and mouth touches decreased, and her sleep pattern improved with the combination of treatment strategies. We discuss our use of a novel mode of service delivery to treat sleep-related problem behavior.

Topics: Behavior Therapy; Child, Preschool; Combined Modality Therapy; Female; Humans; Melatonin; Pica; Sleep; Telemedicine; Trichotillomania

Iron deficiency anemia (IDA) and abdominal pain are commonly seen in a pediatric emergency department (8 and 18% incidence respectively in our center). They are manifestations of a wide variety of diseases ranging from benign to immediately life-threatening. Trichobezoar is an under-diagnosed entity that has to be considered in children and adolescents, expecially female, suffering from trichotillomania (compulsion to pull hair) and trichophagy (compulsion to swallow hair). When undiagnosed, gastric bezoars may cause gastric ulceration, perforation, haemorrhage and obstruction.. To underline the importance of including this pathology in the differential diagnosis of IDA and abdominal pain, we present the case of a 14 year-old girl with a huge trichobezoar which completely filled the stomach and extended into the small bowel. Since trichobezoar has an extension to the small bowel, it is classified as Rapunzel syndrome. As the bezoar couldn't be removed by endoscopy, the girl underwent surgical intervention. The patient passed through a gradual re-feeding, with iron and vitamins supplementation, and through a psychiatric counselling.. The Rapunzel syndrome is a rare entity that may be complicated by life-threatening events. A prompt diagnosis and an appropriate therapy can reduce comorbidities. Gradual re-feeding with supplementation of micronutrients allows adequate catch-up weight with normalization of haematochemical nutritional parameters. Since many of these patients suffer from psychiatric pathology such as PICA with emotional problems and mental retardation, psychological/psychiatric counselling plays an important role in order to prevent bezoar recurrence.

Topics: Abdominal Pain; Adolescent; Anemia, Iron-Deficiency; Bezoars; Diagnosis, Differential; Duodenum; Emergency Service, Hospital; Female; Humans; Pica; Stomach; Syndrome; Tomography, X-Ray Computed; Trichotillomania; Ultrasonography

Topics: Adolescent; Bezoars; Female; Humans; Pica; Trichotillomania

An 11-year-old girl with normal development and good academic progress at school presented with an abdominal mass. She lived with her aunt as her mother suffered from severe bipolar disorder and was unable to raise her. There were also multiple bereavements in the family. She had a history of alopecia and admitted to have eaten her hair to relieve stress. Examination was normal apart from a solid mass in the left hypogastrium. CT abdomen revealed a huge intra-abdominal mass covering most of the lumen. Open laparotomy was performed to remove the mass which was confirmed to be a trichobezoar. She made a good postoperative recovery and was discharged after 7 days. She has been referred to psychology services. Bereavement alone without psychiatric, physical disability or autism can be associated with trichobezoar. More studies are needed to study the association of trichotillomania, trichophagia and trichobezoar.

Topics: Alopecia; Bereavement; Bezoars; Child; Eating; Female; Hair; Humans; Laparotomy; Pica; Stomach; Trichotillomania

Topics: Bezoars; Child; Female; Hair; Humans; Microscopy, Electron, Scanning; Pica; Prognosis; Stomach; Stress, Psychological; Syndrome; Trichotillomania

A 14-year-old female presented with the complaints of loss of hair, scalp pruritus, and pain in the abdomen. On careful work-up, she was found to have trichotillomania as well as trichophagia. Investigations also revealed a trichobezoar which completely filled the stomach. Hemogram showed moderate hypochromic anemia. Her detailed psychiatric profile showed a few additional features like obsessive hand washing, knuckle cracking, nose picking and body rocking. Her trichobezoar was removed surgically, and she had an uneventful post-operative recovery. She is being maintained on fluoxetine and is doing well. The role of a multi-disciplinary approach to trichotillomania patients is highlighted.

Topics: Adolescent; Bezoars; Female; Hair; Humans; Pica; Stomach; Trichotillomania

The case is described of a three-year-old Moroccan girl with iron deficiency anaemia and a bezoar resulting from trichotillomania and trichophagy leading to a slowly developed obstruction ileus. Causes, symptoms and treatment of the various forms of bezoar are discussed.

Topics: Bezoars; Child, Preschool; Female; Humans; Intussusception; Pica; Radiography; Stomach; Trichotillomania

Hair pulling and eating has not yet received attention in the nonhuman primate literature. Hair pulling and eating was recorded 388 times in two heterogeneous troops of healthy rhesus monkeys that were kept according to modern management practices. The behavior in question consists of the following sequence: pulling with the fingers (1/3 of cases) or with the teeth (2/3 of cases) tufts of hair from one's own or from a partner's coat; chewing the hair and finally swallowing it; the undigested material is excreted in the feces. Hair pulling was almost exclusively (378/388) partner-directed. It was observed 364 times between animals whose dominance relationships were known; it was performed in 96% (349/364) of observations by a dominant but only in 4% (15/364) of observations by a subordinate monkey. The recipient of hair pulling showed typical fear and/or avoidance reactions. In both troops young animals (2-8 years of age) engaged in hair pulling and eating significantly more often than old animals (10-26 years of age). There was no evidence that nutritional, toxicological or climatic factors were responsible for the manifestation of this behavior. It was concluded that, similar to trichotillomania in man, wool pulling and eating in sheep and muskox, and feather picking in poultry, hair pulling and eating is an aggressive behavioral disorder in rhesus monkeys reflecting adjustment problems to a stressful environment.

Topics: Animals; Dominance-Subordination; Female; Macaca; Macaca mulatta; Male; Monkey Diseases; Obsessive-Compulsive Disorder; Pica; Social Behavior; Social Dominance; Trichotillomania

Topics: Adrenal Gland Neoplasms; Anemia, Hypochromic; Bezoars; Child, Preschool; Female; Ganglioneuroma; Hair; Humans; Infant; Pica; Trichotillomania