The tangled truth: understanding pediatric gastrointestinal trichobezoars: a case series and literature review

Abstract

Trichobezoars are rare gastrointestinal obstructions caused by the accumulation of ingested hair. They are most commonly found in adolescent females with underlying psychiatric disorders such as trichotillomania and trichophagia. If left untreated, trichobezoars can lead to severe complications, including gastric outlet obstruction, perforation and Rapunzel syndrome.  This study presents case data and the surgical management of pediatric trichobezoars, emphasizing diagnostic challenges and post-treatment psychiatric follow-up and complication management. A retrospective review was conducted on seven pediatric cases of trichobezoars treated at our institution from 2021 to 2025. Demographic data, clinical presentation, imaging findings, endoscopic trials, surgical approach and postoperative outcomes were analysed. All seven cases involved female patients aged 5 to 15 years, presenting with varying degrees of abdominal pain, weight loss, nausea and palpable abdominal masses. Four cases had gastric trichobezoars, while two had ileal extensions (Rapunzel syndrome). Endoscopic retrieval was attempted in one case but failed, necessitating surgical intervention. Surgery was performed in all except one case, followed by gastrotomy or enterotomy for bezoar removal. Last trichobezoar was removed with robotic assistance. Postoperatively, all patients were referred for psychiatric evaluation. Trichobezoars should be considered in pediatric patients presenting with unexplained abdominal complaints and a history of trichophagia. Imaging plays a critical role in diagnosis and while endoscopic retrieval may be attempted, most cases require surgical intervention. A multidisciplinary approach involving pediatric surgery, gastroenterology and psychiatry is essential to prevent recurrence with meticulous management of post-operative complications.