Fatal Gastric Perforation Caused by Undiagnosed Trichobezoar in an Adolescent: A Case Report.

Abstract

Introduction: Trichobezoar is a rare gastrointestinal condition typically caused by ingestion of hair, which most often affects adolescent females. Its clinical presentation is frequently nonspecific, with symptoms such as abdominal pain, constipation, or early satiety, which can delay recognition until severe complications such as obstruction or perforation develop.

Case report: We present the case of a 14-year-old girl who developed a massive trichobezoar resulting in gastric perforation and death. She had a three-month history of intermittent constipation and multiple healthcare visits without definitive diagnosis. On arrival to the emergency department, she was in cardiopulmonary arrest. Computed tomography revealed a large intragastric mass with associated pneumoperitoneum. Emergency laparotomy confirmed a trichobezoar with gastric perforation and diffuse peritonitis. Despite prompt surgical and resuscitative intervention, the patient could not be revived.

Conclusion: This case underscores the importance for emergency physicians to maintain clinical vigilance when adolescents present with persistent, unexplained gastrointestinal symptoms. Trichobezoar should be considered in the differential diagnosis, even in the absence of psychiatric history. A low threshold for advanced imaging is warranted, as early recognition and intervention may prevent fatal complications such as gastric perforation and septic shock.