GASTRIC TRICHOBEZOAR - an ultrasound diagnosis

GASTRIC TRICHOBEZOAR - An ultrasound diagnosis

BEZOAR- accumulation of undigested injested material within GIT. Gastric trichobezoar is formed by accumulation of injested hairs in stomach . It is hair ball mass usually take shape of stomach. It is seen commonly in mentally subnormal females who used to injest their own hairs.  Rapunzel syndrome is same condition in which a long tail like extension of bezoar noted reaching in small bowel causing its obstruction. Other types of bezoars are - phytobezoar ( formed by undigested food materials) ,  pharmacobezoar ( formed by drugs) , lactobezoar ( by milk products) .

CASE DETAILS
A  12 yr female child with pain & lumpish feel upper abdomen, occasional vomiting & loosing weight.
She was slightly mentally subnormal . On clinical examination upper abdominal lump was seen . Routine lab tests were noncontributory .
AT USG
A large complex mass was noted in upper abdomen , seen as a huge echodensity  in the region of stomach . The mass was filling & occupying entire stomach lumen with few visible thick gastric rugae . The mass was so large to cast a huge semilunar or crescentic echodensity with distal shadowing obscuring underlying details. No any other thing was seen except a huge echodense structure , that was traced in entire gastric cavity [ Fig 1-2] . Rest of the abdominal findings were normal on ultrasound . On the basis of sonographic findings a diagnosis of gastric trichobezoar was made , which was confirmed at surgery  [ Fig - ].

Fig 1- A midline sagittal US scan upper abomen shows part of left lobe liver , thick stomach rugae & a large semilunar echodensity [arrows ] filling entire stomach cavity

Fig 2 - Epigastric US scan shows a huge echodensity [ gastric bezoar ]  with distal shadowing

Fig 3- per operative images shows mass ( trichobezoar) distending  the stomach , & during its removal 

Fig 4- Post operative gross specimen (trichobezoar taken shape of stomach)


PS 1] The case study in intended for radiologists & sonologists for academic  purpose
     2 ] I expresss my sincere thanks to Dr Gaurav Bahety , M . Ch [pediatric surgery], Bhilwara -Rajasthan for operative details