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Introducción: La tricotilomania, la tricofagia y el tricobezoar son afecciones entrelazadas e interconectadas. Estas deben tenerse en cuenta especialmente en féminas jóvenes que a menudo tienen una enfermedad psiquiátrica o trastorno social subyacente y es posible que la historia sea difícil de obtener. Objetivo: Presentar un caso portador de tricobezoar gástrico, por su baja incidencia en nuestro medio y a nivel mundial. Caso clínico: Paciente femenina de 12 años de edad, con antecedentes de retraso psicomotor, sin seguimiento o tratamiento previo. Acudió a consulta traída por su madre que aduce aumento de volumen en hemiabdomen superior de 5 años de evolución con pérdida de peso insidiosa. Los estudios radiológicos revelaron un tricobezoar gástrico que se corrobora, asociado a un síndrome de Rapunzel, en la laparotomía exploratoria. La paciente evolucionó satisfactoriamente y es seguida por grupo multidisciplinario. Conclusiones: Los bezoares gástricos son entidades poco frecuentes. Para el diagnóstico es necesario un alto índice de sospecha de conjunto con estudios radiográficos y/o endoscópicos. El tratamiento estará determinado por el tipo de bezoar, tamaño y consistencia. La opción quirúrgica es la más usada, con el consecuente seguimiento interdisciplinario para evitar recurrencias(AU)

Introduction: Trichotillomania, trichophagia and trichobezoar are intertwined and interconnected conditions. These should be considered, especially in young women who often have an underlying psychiatric illness or social disorder and possibly a history difficult to get. Objective: To report a case of gastric trichobezoar due to its low incidence in our environment and worldwide. Clinical case report: We report the case of a 12-year-old female patient with a history of psychomotor retardation, with no prior follow-up or treatment, who came to consult with her mother, complaining of increased volume in the upper abdomen, of 5 years of evolution with malignant weight loss. Radiological studies reveal a gastric trichobezoar that is corroborated, associated with Rapunzel syndrome, in the exploratory laparotomy. The patient evolved satisfactorily and a multidisciplinary group assisted her. Conclusions: Gastric bezoars are rare entities. Diagnosis requires high level of suspicion together with radiographic and/or endoscopic studies. The treatment will be determined by the type of bezoar, size and consistency. The surgical option is the most used, requiring interdisciplinary follow-up to avoid recurrences(AU)

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BACKGROUND: Rapunzel syndrome is the formation of a trichobezoar that extends beyond the small intestine. Since its discovery few cases have been reported in the literature with variable clinical characteristics, causing important complications such as intestinal obstruction. Laparotomy is currently considered the treatment of choice. CASE REPORT: We present the clinical case of a patient who presented with recurrent peritonitis associated with a peritoneal dialysis catheter, anorexia, nausea, vomiting, without channeling or presenting evacuations, epigastric tumor, anxiety, trichotillomania and trichophagia. Rapunzel syndrome is diagnosed and admission to the operating room is decided.

ANTECEDENTES: El síndrome de Rapunzel es la formación de un tricobezoar que se extiende más allá del intestino delgado. Desde su descubrimiento, pocos casos se han reportado en la literatura y con características clínicas variables, provocando complicaciones importantes como obstrucción intestinal. Actualmente, la laparotomía se considera el tratamiento de elección. CASO CLÍNICO: Paciente de sexo femenino que acude por presentar peritonitis de repetición asociada a catéter de diálisis peritoneal, anorexia, náuseas, vómito, sin canalizar ni presentar evacuaciones, tumoración en epigastrio, ansiedad, tricotilomanía y tricofagia. Se realiza el diagnóstico de síndrome de Rapunzel y se decide su ingreso a quirófano.

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Grooming is a natural hygienic behaviour of cats that favours the formation of hairballs. Increased fibre concentration in the diets is a strategy to minimize hairball formation, but it is not fully effective. Because cat hair is formed mostly by keratin, the addition of keratinases in the diets might be an alternative for hairball control. Thus, the objective was to evaluate the effect of the combined use of sugarcane fibre and a protease complex to reduce the hairball excretion in cats. Twenty-four adult cats were divided into four treatment groups (n = 6 per treatment) in a 2 × 2 factorial arrangement. Treatments were as follows: control diet (Control; containing low concentration of insoluble fibre, 5.34% of total dietary fibre), control diet plus enzyme (Co-e), high-fibre diet (HF; containing high amounts of insoluble fibre, 17.8% of total dietary fibre), and HF diet plus enzyme (HF-e). Proteases from Bacillus licheniformis PWD-1 were administered orally (5 mg/day) as gastro-resistant capsules. Total collection of faeces was carried out to determine the number of excreted hairballs and the coefficient of total tract apparent digestibilities (CTTAD) of the diets. Separate addition of insoluble fibre (HF; p = .5947) or enzyme complex (Co-e; p = .3633) had no effect on the hairballs excreted in the faeces. However, the combined use of insoluble fibre and enzymes (HF-e) reduced (p = .0344) the total number of hairballs excreted. The size distribution of hairballs (small, medium, or large) was not affected by treatments (p = .3763). The CTTAD of crude protein was not affected by protease addition (p = .781) but was reduced by HF and HF-e treatments. Sugarcane fibre associated to keratinolytic enzymes reduces the hairball excretion in cats. This strategy can be adopted for this purpose; however, methods for faecal hairball quantification must be improved. If you have not already completed a Copyright Transfer Agreement, please log on to Wiley Author Serivices, https://authorservices.wiley.com/bauthor/, sign-in and complete the License Agreement form".

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Resumen Se presenta el caso de una paciente de 35 años, quien ingresa al servicio de urgencias de un hospital de tercer nivel, por causa de un cuadro de 6 meses de saciedad precoz, pérdida de peso y, en el momento del examen físico de ingreso, se observan signos de desnutrición. En consecuencia, se realiza una endoscopia de las vías digestivas altas en las que se descubre un tricobezoar que ocupa toda la cámara gástrica y se extiende más allá de la tercera porción del duodeno. Mediante una tomografía axial computarizada (TAC) de abdomen, se confirma la presencia de una lesión que ocupa la cámara gástrica y el duodeno, por lo que la paciente es conducida a cirugía. Allí se encuentra el tricobezoar que confirma el diagnóstico de síndrome de Rapunzel. Luego de la cirugía, la paciente presenta una adecuada evolución posoperatoria, con resolución de los síntomas de ingreso. Asimismo, se inicia una intervención por nutrición y psicología, a fin de manejar la desnutrición y el trastorno psiquiátrico de base.

Abstract A 35-year-old patient was admitted to the emergency department of a third-level hospital following six months of early satiety and weight loss. Upon physical admission, the patient had signs of malnutrition. Upper digestive tract endoscopy found a trichobezoar that occupied the entire gastric chamber and extended into the third portion of the duodenum. This diagnosis was confirmed by an abdominal CT scan. Surgery confirmed the diagnosis of Rapunzel Syndrome. Following surgery the patient's evolution was good and symptoms resolved. Nutritional and psychological interventions were initiated to manage malnutrition and an underlying psychiatric disorder.

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Los tricobezoares pertenecen a la clasificación de los bezoares, tumores abdominales formados por el acumulo de diversas sustancias que pueden ocasionar la oclusión intestinal, se presenta un paciente, femenina, que acuda al médico por presentar dolor abdominal y vómitos, en el examen físico abdominal se palpa una masa de aproximadamente 5 cm en el epigastrio que aparece y desaparece con los movimientos intestinales, se plantea inicialmente la posibilidad de padecer de una neoplasia abdominal, se realiza una endoscopia en donde informe que, en el fondo gástrico, cuerpo y antro está ocupado por cabello y restos alimenticios mal digeridos, la cual es removida mediante una laparotomía sobre el área que ocupaba la tumoración en el intestino delgado extrayendo un tricobezoar de 35 cm de longitud por 10 de ancho(AU)

The trichobezoars belong to the classification of bezoars, abdominal tumors formed by the accumulation of various substances that can cause intestinal occlusion, a patient, female, who comes to the doctor due to abdominal pain and vomiting, in the abdominal physical examination is presented palpa a mass of approximately 5 cm in the epigastrium that appears and disappears with bowel movements, initially poses the possibility of suffering from an abdominal neoplasm, an endoscopy is performed where it reports that, in the gastric fundus, body and antrum is occupied by hair and badly digested food remains, which is removed by a laparotomy on the area occupied by the tumor in the small intestine, extracting a trichobezoar measuring 35 cm long by 10 cm wide(AU)

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BACKGROUND: Adult intestinal intussusception is a rare condition caused by the mechanical disruption of bowel motility. A bezoar is defined as indigestible material inside the gastrointestinal tract that develops into a trapped mass; the most frequent bezoar is a trichobezoar. When a trichobezoar extends into the small intestine it is defined as Rapunzel's syndrome. Literature describing complications related to this pathology remains scarce. CASE PRESENTATION: A 16-year-old Mexican girl presented to our emergency room with acute abdomen and a presumptive diagnosis of intestinal obstruction. Computed tomography was suggestive of intussusception. Surgery confirmed a jejunal-jejunal intussusception with a mass within the gastric cavity extending into her small intestine, corresponding to a trichobezoar. A manual intussusception reduction and a gastrotomy with extraction of the trichobezoar were performed. CONCLUSIONS: We present a case of a jejunum intussusception as a complication of Rapunzel syndrome. Our patient had a favorable outcome after surgical intervention with a manual intussusception reduction, with retrograde displacement of the trichobezoar into the gastric lumen, and a complete extraction through a gastrostomy. Follow-up included psychiatric evaluation.

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Bezoars are conglomerations of undigested foreign material retained in the gastrointestinal tract. Trichobezoar is a compact conglomeration of swallowed hair and constitutes less than 6% of all bezoars. Their most frequent location is in the stomach but they may extend through the pylorus into the small bowel. This condition is known as Rapunzel syndrome. Many patients may remain asymptomatic or present a mild form of the disease characterized by abdominal pain, early satiety, nausea, and vomiting. Complications may manifest as gastric outlet obstruction or bleeding, and intestinal obstruction. A 15-year-old female patient presented with clinical findings of intestinal obstruction. The patient suffered from depressive and anxiety disorders and trichotillomania, although trichophagy could not be assured. Alopecia circumscripta and irregular hair length on the scalp were identified. A computed tomography (CT) scan showed two images highly suggestive of trichobezoars, one in the stomach and the second one causing obstruction at the ileocecal valve. At laparotomy, both a mobile gastric trichobezoar with a tail extending to the duodenum and a trichobezoar causing obstruction at the ileocecal valve were removed. The postoperative course was uneventful. The passage of a detached trichobezoar fragment in a patient with Rapunzel syndrome may cause intestinal obstruction. CT is the preferred image modality for the evaluation of suspected trichobezoars in order to characterize their size and locations, the presence and level of obstruction, and complications such as ischemia or perforation. A case of small-bowel obstruction secondary to ileal trichobezoar in a patient with Rapunzel syndrome is herein reported.

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Resumen: Introducción: Los tricobezoares son acúmulos intraluminales de cabello ingerido. El síndrome de Rapunzel hace referencia a la presencia de los tricobezoares gástricos que se extienden al intestino delgado, sumados a la tricotilomanía y tricofagia, los cuales ocurren preferentemente en pacientes psiquiátricos en edad pediátrica. Objetivo: Analizar la aparición y manejo de este síndrome, propor cionando de igual manera datos acerca del entorno familiar y psicoemocional para que, por medio del análisis de los mismos, en un futuro se pueda identificar el riesgo en pacientes con circunstancias similares. Caso clínico: Paciente femenina de 14 años con antecedentes de tricotilomanía y tricofagia de dos años de evolución, que consultó por cuadro de dolor epigástrico asociado a sensación de plenitud posprandial, náuseas y pérdida de peso. Al examen destacaban áreas alopécicas en el cuero cabelludo y a la palpación abdominal se identificó un plastrón cuyo contorno parecía corresponder a los límites gástricos. En los estudios de imágenes se encontró una ocupación gástrica por bezoar. Con la laparotomía más gastrostomía se identificaron dos tricobezoares simultáneos en estómago y duodeno, que fueron resueltos quirúrgicamente y la paciente fue manejada con abordaje psicoemocional. Conclusión: El síndrome de Rapunzel, lejos de ser meramente una entidad quirúrgica, requiere un apoyo psicoemocional para prevenir su recurrencia y limitar su severidad.

Resumen: Introduction: Trichobezoars are an intraluminal accumulation of ingested hair. The Rapunzel syndrome refers to the presence of gastric trichobezoars which extend to the small intestine together with trichotillomania and trichophagia, that occur predominantly in psychiatric patients of pediatric age. Objective: To analyze the clinical course and resolution of this syndrome in a case report. Likewise, we provide information about the family environment and psycho-emotional context of the patients and help the reader identify similar circumstances in their clinical practice. Case report: Female 14-year-old patient with history of trichotillomania and trichophagia of two years of evolution, who consulted for epigastric pain associated with weight loss, nausea, and postprandial fullness. During the physical examination, the patient was found to have bald patches in the scalp along with a palpable mass that seemed to be confined to the gastric limits. Imaging studies revealed gastric occupation due to a bezoar formation. The patient was treated surgically with laparotomy and gastrostomy, and two simultaneous trichobezoars were removed from the patient´s stomach and duodenum, the patient also underwent psycho-emotional professional counseling. Conclusion: Rapunzel´s syndrome, far for being a merely surgical entity, also requires psychoemotional assessment to prevent it recurrence and limit its severity.

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Resumen Objetivo: Presentar un caso de síndrome de Rapunzel. Esta es una enfermedad poco frecuente que consiste en una variante de tricobezoar gástrico que se extiende hasta la segunda porción del duodeno. Caso clínico: Paciente femenina adolescente con antecedentes de atresia tricuspídea tratada quirúrgicamente. Presentó dolor abdominal de 3 días de evolución en el hipocondrio izquierdo irradiado al hipocondrio derecho, con distensión abdominal, náuseas y vómitos. Al examen físico presentó un perímetro abdominal de 58 cm y ruidos hidroaéreos disminuidos. La laparotomía exploratoria con gastrostomía anterior mostró una masa de cabellos entrelazados de aproximadamente 40 cm de longitud, compatible con tricobezoar, que se extendió desde el fondo gástrico hasta la segunda porción, llamado síndrome de Rapunzel, provocando suboclusión intestinal. Conclusión: El diagnóstico temprano permite evitar complicaciones, que pueden ser graves. Se recomienda un manejo multidisciplinario con el servicio de psiquiatría para controlar la enfermedad de base.

Abstract Aim: Present a case of Rapunzel syndrome, this is a rare disease that is a variant of gastric tricobezoar which extends to the second portion of duodenum. Case report: Female patient with tricuspid atresia treated surgically. Abdominal pain three days of evolution on the left upper quadrant radiating to the right upper quadrant with abdominal distension, nausea and vomiting. Abdominal circumference was 58 cm, decreased bowel sounds. The exploratory laparotomy presenced of a mass formed by interlocking hair, approximately 40 cm long with a compatible tricobezoar that spread from the gastric fundus to the duodenum called Rapunzel síndrome and caused partial bowel obstruction. Conclusion: Early diagnosis can prevent complications, which can be severe, a multidisciplinary management is recommended in psychiatry service to control the underlying disease.

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Hairball formation may induce vomiting and intestinal obstruction in predisposed cats. Some insoluble fibres as sugarcane fibre and cellulose can prevent hairball formation. The aim of this study was to evaluate the effect of beet pulp consumption, a moderate soluble and fermentable fibre source, on faecal trichobezoars excretion in adult shorthaired cats fed kibble diets. Eighteen mixed-breed shorthaired cats and three extruded diets were used as follows: a basal diet without added fibre source (PB0-8.8% dietary fibre); BP8-8% inclusion of beet pulp (17.5% of dietary fibre); BP16-16% inclusion of beet pulp (23.8% of dietary fibre). The cats were fed during 31 days and faeces quantitatively collected during three periods of 3 days each (from days 3-5; 15-17; 26-28). Gastrointestinal transit time was determined in the last 3 days of study (from days 29-31). The trichobezoars were separated from faeces, collected, dried and washed in ether for complete removal of all faecal material. The results were submitted to repeated-measure analysis of variance and means evaluated by polynomial contrast (p < 0.05). Beet pulp increased faecal production (p < 0.001) and reduced gastrointestinal transit time (p = 0.003). No alterations were found on trichobezoar faecal excretion, both as considered in number per cat per day of mg per cat per day (p > 0.05). Beet pulp intake did not reduce the number or the size of hairballs eliminated via faeces of shorthaired cats.

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El Tricobezoar es la acumulación de pelo en el tracto gastrointestinal generalmente asociado a trastornos psiquiátricos que conlleva a sintomatología obstructiva, deficiencias metabólicas y puede llevar a perforación intestinal, pancreatitis, intususcepción y colangitis. Caso: Paciente femenina de 11 años con cuadro clínico de 1 semana de evolución de dolor abdominal en epigastrio asociado a ausencia de deposiciones y antecedente de cuadro similar hace 2 semanas que resolvió con enema oral, se documentó Tricobezoar de 13 x 5 cm que generaba gran distensión en asas intestinales que fue removido por laparotomía con éxito. Conclusiones: Es una patología poco común asociada a un trastorno psicológico, que debe ser manejada quirúrgicamente en pro de prevenir complicaciones e incluye un tratamiento conjunto con psiquiatría y psicología para evitar recurrencias.

The Trichobezoar is the accumulation of hair on the gastrointestinal tract associated with psychiatric disorders generally leading to obstructive symptoms, metabolic deficiencies and, in some cases, intestinal perforation, pancreatitis, cholangitis or intussusception. Case: 11 years old female patient with clinical symptoms of 1 week duration of epigastric abdominal pain associated with bowel movements, patient referred history of similar symptoms two weeks ago that resolved with oral enema, tomography revealed a Trichobezoar 13 x 5 cm generating large strained bowel loops which was successfully removed by laparotomy. Conclusions: Trichobezoar is a rare entity associated with a psychological disorder that needs to be handled surgically towards preventing complications and includes a set psychiatric and psychological treatment to prevent recurrences

Trichobezoar é o acúmulo de pêlos no trato gastrointestinal associado com transtornos psiquiátricos geralmente levando a sintomas obstrutivos, deficiências metabólicas e, em alguns casos, perfuração intestinal, pancreatite, colangite ou intussuscepção. Caso: Paciente do sexo feminino com 11 anos de idade com sintomas clínicos de 1 semana de duração da dor abdominal epigástrica associada a movimentos intestinais, paciente relatou história de sintomas semelhantes há duas semanas que resolveram com enema oral, a tomografia revelou um tricobezoar de 13 x 5 cm, foi removido com sucesso por laparotomia. Conclusões: Trichobezoar é uma entidade rara associada a um transtorno psicológico que precisa ser tratado cirurgicamente para prevenir complicações e inclui um conjunto de tratamento psiquiátrico e psicológico para prevenir recorrências

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El tricobezoar es una masa de cabello no digerido que se encuentra en las vías gastrointestinal. Se alojan frecuentemente en el estómago pero se pueden ubicar a todo lo largo del tracto gastrointestinal. Se observan en sexo femenino en el 90% de los casos, y con una mayor frecuencia entre los 10 y 19 años. Se presenta el caso de una adolescente femenina de 11 años de edad quien cursa con enfermedad actual de 1 mes de evolución caracterizada por dolor abdominal, vómitos alimenticios pospandriales y pérdida de peso. Al examen se palpa una masa que ocupa el hemiabdomen superior. Se realiza tomografía computarizada de abdomen donde se evidencia imagen hipodensa y heterogénea que ocupaba la totalidad del estómago, compatible con cuerpo extraño. Se realiza laparotomía exploradora donde se evidencia tricobezoar gástrico.

Trichobezoar is a mass of undigested hair found within the gastrointestinal tract. They are often found in the stomach but may be found along the entire gastrointestinal tract. 90% of the cases occur in females between the age of 10 and 19 years. We present the case of an 11 years old girl who suffered abdominal pain, vomiting and weight loss for a month, with a palpable mass located in the upper abdomen quadrant. Abdomen computed tomography reported a hypodense heterogeneous image which occupied the whole of the stomach, compatible with foreign body. At laparotomy a gastric tricobezoar was found.

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RESUMEN Los bezoares son masas sólidas compuestas por fibras, pelos o restos de comida ingeridos que generalmente permanecen en el estómago. Los tricobezoares, que están formados por pelos, son más comunes en el sexo femenino en edad pediátrica con antecedentes de tricotilomanía y tricofagia. Para el diagnóstico se utilizan imágenes como la radiografía simple de abdomen, la radiografía de abdomen con bario y la endoscopia digestiva alta que permite la visualización directa. El tratamiento del tricobezoar es quirúrgico, con gastrostomía anterior, además de apoyo psiquiátrico. Este caso corresponde a una paciente de 16 años con antecedentes de tricofagia, que consulta por un cuadro de dolor abdominal, vómitos y distensión abdominal. Se realiza estudios laboratoriales, imagenológicos y endoscópicos llegando al diagnóstico de obstrucción intestinal mecánica alta. Se indicó cirugía y se confirmó tricobezoar que es extraído por gastrotomía anterior. La evolución fue favorable, por lo cual egresó al quinto día del post operatorio, con recomendaciones de asistir a consultas externas de cirugía general y psicología.

ABSTRACT Bezoars are solid masses made up of fibers, hairs or food debris that usually remain in the stomach. Trichobezoars, which are formed by hairs, are more common in female patients with a history of childhood trichotillomania and trichophagia. For diagnosis, imaging techniques like plain abdominal radiography, barium contrast abdominal radiography and upper gastrointestinal endoscopy are used that allow direct visualization. Treatment for trichobezoar is surgical, consisting of anterior gastrostomy in addition to psychiatric support. Our case corresponds to a 16-year old patient with a history of trichophagia, that consulted for abdominal pain, vomiting and abdominal distension. Laboratory, imaging and endoscopic studies were conducted leading to the diagnosis of higher intestinal mechanical obstruction. Surgery was indicated confirming the trichobezoar that was removed by anterior gastrostomy. Evolution was favorable, whereby the patient egressed five days after surgery, with recommendations to attend outpatient general surgery and psychology.

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A bezoar is an intraluminal mass formed by the accumulation of undigested material in the gastrointestinal tract. Trichobezoar is a rare condition seen almost exclusively in young women with trichotillomania and trichotillophagia. When not recognized, the trichobezoar continues to grow, which increases the risk of severe complications such as gastric ulceration and even perforation. Formation of a gallstone within the trichobezoar (tricholithobezoar) is an event that has not yet been described. We report the case of a 22-year-old woman admitted to the emergency room with signals and symptoms of an epigastric mass and perforative acute abdomen. Radiological study revealed bilateral pneumoperitoneum. Personal history revealed depressive syndrome, trichotillomania and trichophagia. With a diagnosis of visceral perforation, an urgent exploratory laparotomy was performed. This confirmed the diagnosis of gastric perforation due to a large trichobezoar with the formation of a gastrolith that was removed by anterior gastrotomy. Biochemical study of the gastric stone revealed that it was composed of bile salts. There were no complications. The patient was discharged on the 5th postoperative day and was referred for psychiatric treatment.

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Cuando los cuerpos extraños permanecen en el tubo digestivo del hombre por largo tiempo y resisten la acción de los jugos digestivos, forman concreciones a las que se les denomina bezoares. Los bezoares pueden estar compuestos por uno o varios tipos de materia, como los pelos de las personas (tricobezoares). En este trabajo se analiza el caso de una paciente femenina, de 24 años de edad, procedencia rural, que acude a servicio de urgencias por la presencia de dolor abdominal difuso, fundamentalmente en epigastrio, y que se irradia a todo el abdomen; además presenta vómitos y diarreas que contienen pelos. La endoscopia digestiva alta evidenció un cuerpo extraño que ocupaba toda la luz gástrica. Se realizó laparotomía exploradora y gastrotomía longitudinal anterior, en la que se encontró una gran masa compacta de aspecto oscuro. El informe anatomopatológico de la pieza, describió una muestra con forma de masa alargada, compuesta por pelo procedente del cuero cabelludo(AU)

When foreign bodies remain in the human digestive tract for a long time and tolerate the digestive juices, the produce concretions called benzoars, which may be composed by one of several types of matter, by example the hairs (trichobezoars). The objective of present paper is to analyze the case of a female patient aged 24 arriving from rural zones, who came to emergency services due to a diffuse abdominal pain, mainly in epigastrium irradiating to all the abdomen; also, had vomiting and diarrheas containing hairs. The high digestive endoscopy demonstrated a foreign body occupying all the gastric lumen. An exploratory laparotomy and anterior longitudinal gastrotomy were carried out noting a large compact mass of obscure appearance. The sample anatomical-pathological report described an enlarged mass consisting of hair from the scalp(AU)

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Objetivo: relatar o caso de uma criança que se apresentou com quadro clínico de dor abdominal a esclarecere chamar a atenção para a possibilidade do diagnóstico precoce de bezoar. Relato de caso: criança, 09 anos,com quadro de dor epigástrica intensa e massa palpável no abdome. Foi submetida a examescomplementares que levantaram a possibilidade de semi-oclusão e corpo estranho. Submetida à laparotomiaexploradora para retirada de tricobezoar gastro-duodenal; evoluiu sem intercorrências e teve alta paraacompanhamento ambulatorial. Conclusão: fica evidente a importância do diagnóstico precoce de bezoar,face às complicações que podem advir desta condição, e da abordagem multidisciplinar, para o completorestabelecimento do paciente.

Objective: report a case of a child who presented clinical symptoms of abdominal pain, and draw attentionto the possibility of early diagnosis of bezoar. Case report: child, 09 years, with signs of severe epigastricpain and palpable mass in the abdomen. Underwent additional tests that raised the possibility of semiocclusionand foreign body. Subjected to laparotomy for removal of gastro-duodenal trichobezoar,progressed uneventfully and was discharged for outpatient monitoring. Conclusion: It is clearly theimportance of early diagnosis of bezoar, given the complications that may arise from this condition, and themultidisciplinary approach to the patient full recovery.

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Cuando los cuerpos extraños permanecen en el tubo digestivo del hombre por largo tiempo y resisten la acción de los jugos digestivos, forman concreciones a las que se les denomina bezoares. Los bezoares pueden estar compuestos por uno o varios tipos de materia, como los pelos de las personas (tricobezoares). En este trabajo se analiza el caso de una paciente femenina, de 24 años de edad, procedencia rural, que acude a servicio de urgencias por la presencia de dolor abdominal difuso, fundamentalmente en epigastrio, y que se irradia a todo el abdomen; además presenta vómitos y diarreas que contienen pelos. La endoscopia digestiva alta evidenció un cuerpo extraño que ocupaba toda la luz gástrica. Se realizó laparotomía exploradora y gastrotomía longitudinal anterior, en la que se encontró una gran masa compacta de aspecto oscuro. El informe anatomopatológico de la pieza, describió una muestra con forma de masa alargada, compuesta por pelo procedente del cuero cabelludo

When foreign bodies remain in the human digestive tract for a long time and tolerate the digestive juices, the produce concretions called benzoars, which may be composed by one of several types of matter, by example the hairs (trichobezoars). The objective of present paper is to analyze the case of a female patient aged 24 arriving from rural zones, who came to emergency services due to a diffuse abdominal pain, mainly in epigastrium irradiating to all the abdomen; also, had vomiting and diarrheas containing hairs. The high digestive endoscopy demonstrated a foreign body occupying all the gastric lumen. An exploratory laparotomy and anterior longitudinal gastrotomy were carried out noting a large compact mass of obscure appearance. The sample anatomical-pathological report described an enlarged mass consisting of hair from the scalp

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RESUMEN

Los tricobezoares son una condición poco común que usualmente ocurre en mujeres jóvenes con una historia de tricotilomanía y tricofagia. En la actualidad, la mayoría de los casos se presentan en pacientes con antecedentes de cirugía gástrica, o con alteraciones en la función pilórica; clínicamente pueden cursar asintomáticos durante meses o años o presentarse como una entidad aguda acompañada por sus complicaciones. En el presente artículo se presenta el caso clínico de una paciente embarazada a quien se le realizó diagnóstico de tricobezoar gastroduodenal - síndrome de Rapunzel (una variedad compleja de este bezoar que involucra estómago, duodeno e intestino); se presenta una revisión de la literatura al respecto.

The presence of trichobezoars is a rare condition which usually occurs in young women who have histories of trichotillomania and trichophagia. Nowadays, the majority of cases occur in patients with a history of gastric surgery, or pyloric function alteration. They may be clinically asymptomatic for months or years or may present acute symptoms accompanied by severe complications.This article presents the case of a pregnant patient who was diagnosed with a case of Rapunzel syndrome a is presented. This complex variety of gastroduodenal trichobezoar involves the stomach, duodenum and intestine. The article also reviews the literature about the Rapunzel syndrome.

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RESUMEN

Los bezoares del tracto digestivo constituyen una patología infrecuente, son colecciones de material ingerido que se acumula en estómago e intestino. El tricobezoar hace referencia a un cúmulo de pelo, su sospecha clínica se establece en pacientes jóvenes predominantemente mujeres con historia de masa epigástrica, pérdida de peso y síntomas obstructivos. El diagnóstico se puede realizar con imágenes y endoscopia y su tratamiento consiste en su remoción. Se presenta un caso de tricobezoar perforado en paciente femenina joven, el cual es manejado en el servicio de Cirugía General del Hospital Universitario de Santander.

The gastrointestinal tract bezoars are considered an infrequent pathology; they are collections of ingested material that accumulates in the stomach and intestines. Trichobezoar refers to the cumuli of hair; its clinic suspicion is established in young patients, especially women with history of an epigastric mass, weight loss and obstructive symptoms. Diagnosis can be made by imaging and endoscopy and the treatment consists in its removal. It is presented a case of a young female patient with a perforated trichobezoar which was treated at our service of General Surgery of the Hospital Universitario de Santander.

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RESUMEN

Bezoars are foreign bodies impacted in the digestive tract resulting of their ingestion and accumulation, involving mainly the stomach. The most common types are phytobezoars, contaning vegetables, fiber and seed and the trichobezoar, made of hair. The present case is the description of a 25-year-old female with nonspecific dyspeptic symptoms associated to intestinal habit change. The diagnosis was suggested by Computerized Tomography in association with clinical history - initially omitted by the pacient - of trichophagia for 10 years. Treatment consisted of Anterior Gastrotomy and remotion of the bezoar.

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