Abstract

To the Editor:

A thirteen-year-old female was admitted to Children's Hospital of Michigan with abdominal pain, vomiting, and a diagnosis of acute pancreatitis. Laboratory studies were remarkable for hypochromic microcytic anemia, elevated amylase, and lipase levels. Past medical history included iron deficiency anemia, depression, obsessive compulsive disorder, pica, and trichotillomania. An upper endoscopy performed six months prior to this presentation for evaluation of upper abdominal pain was unremarkable. The patient's home medications were fluoxetine, griseofulvin, and oral contraceptive pills. On examination, patchy alopecia was noticed on the patient's scalp. She had diffuse abdominal tenderness but no distension, and no masses were palpated. A plain abdominal film showed a diffuse mass in the stomach and possibly in the duodenum. An ultrasound of the abdomen was a limited study secondary to gaseous distension of the abdomen, but it did show a normal pancreatic head. An upper gastrointestinal (GI) study revealed a large bezoar in the stomach extending into the duodenum with dilatation distally. Due to the size and extent of the trichobezoar, surgical removal was recommended. The stomach and small intestines were explored and a large mass of hair and particulate material measuring 21.0 × 17.0 × 5.0 cm in aggregate was removed. Grossly, trichobezoar consisted of multiple clumps of brown hair intermixed with a small amount of vegetative material. The patient was maintained initially with nothing by mouth (NPO), and the postoperative course was uneventful. The lipase and amylase levels started to normalize after six days, and, on day eight, a regular diet was started. The patient was discharged, when she was clinically stable. Griseofulvin was discontinued, as the alopecia was considered due to trichotillomania.