Gastric Trichobezoar in a 6-Year Old Girl

A 6-year old girl was seen by local practitioner with complaints of fever. On routine examination a lump was palpable in the epigastric and the left hypochondriac regions. There were no associated symptoms like hematemesis, melena, abdominal pain, distension of abdomen or vomiting. There was no history of abnormal behavior. Her developmental history was appropriate for age. The patient had not gained any weight over the last 1 year. There was no history of trichophagia. On examination of abdomen, it was soft, non-distended, with non-tender firm lump palpable in the epigastrium and left hypochondrium. The lump was barely mobile. The patient was anemic, which was treated by oral iron supplements. An ultrasound examination of the abdomen showed echogenic opacities in stomach suggestive of food particles. The CT scan of abdomen showed presence of a well circumscribed mass in the body and pylorus of stomach showing typical whorled appearance suggestive of trichobezoar. The upper GI endoscopy confirmed the presence of fairly large size of trichobezoar in the stomach without any extension to the duodenum (Fig.1). Laparotomy was performed and trichobezoar was manipulated through the gastrotomy incision and removed in one piece (Fig.2). Post-operative period was uneventful. A psychiatry opinion was sought during the hospital stay which was normal. The child was advised for follow-up.