Jejunal trichobezoar causing small bowel perforations in a child: A case report

Introduction

Trichobezoar is a rare gastrointestinal foreign body predominantly affecting young females. While typically confined to the stomach, migration can result in severe complications, including obstruction and perforation.

Case presentation

A previously healthy 5-year-old female presented with acute abdominal pain, vomiting, and intolerance to oral intake. Initial imaging, including ultrasound and MRI, was inconclusive, but a subsequent CT scan revealed duodenal intussusception and significant gastric content. After endoscopy, the patient developed peritonitis, necessitating emergency surgery. Fourteen full-thickness perforations were identified along the mesenteric side of the jejunum, caused by a migrating trichobezoar. Ninety centimeters of small bowel was resected during the initial surgery, followed by two additional procedures for abdominal washout and resection of 15 cm of non-viable bowel. Pathology confirmed the diagnosis of trichobezoar. The patient recovered fully, tolerating oral feeds without recurrence of symptoms, and was discharged after 28 days of hospitalization.

Conclusions

Trichobezoars of the small bowel are rare but should always be included in the differential diagnosis of children presenting with acute abdominal pain, even in the absence of a psychiatric history.