Trichobezoar causing recurrent gastric ulcer and perforation
A 17-year-old girl was admitted to the hospital with a 1-day history of increasing left-sided chest discomfort and upper abdominal pain. Five years ago, the patient underwent surgery for gastric perforation caused by a large trichobezoar.
Physical examination revealed signs of an acute abdomen with rebound tenderness and pain on removal of pressure to the abdomen. Body temperature was 38 °C. Laboratory examination revealed a leukocyte count of 12.4 × 103/µl, and C-reactive protein was 225.7 mg/dl. On abdominal X-rays, free gas was visible in the abdominal cavity indicating gastrointestinal perforation. Surgery revealed a giant trichobezoar measuring a length of 50 cm and a diameter of 10 cm. A peritoneal wash and closure of perforation were performed. The postoperative course was complicated by a subphrenic abscess on day 6 requiring relaparotomy and drainage. The patient was treated with antibiotics, and further recovery was uneventful.