The
n e w e ng l a n d j o u r na l
of
m e dic i n e
images in clinical medicine Lindsey R. Baden, M.D., Editor
Trichobezoar B
A
D
C
Martin Gaillard, M.D. Hadrien Tranchart, M.D. Antoine Béclère Hospital Clamart, France
[email protected]
A
17-year-old girl with a history of autism and trichotillomania presented to the emergency department with vomiting and abdominal pain of 48 hours’ duration. The vital signs and results of a complete blood count and basic metabolic panel were unremarkable. Abdominal computed tomography with intravenous contrast revealed a heterogeneous, meshlike mass extending from the stomach into the duodenum, a finding consistent with a bezoar (Panels A and B, arrowheads). Endoscopic removal of the bezoar was attempted both before and after a 7-day trial of enzymatic dissolution with papain (administered orally as pineapple juice). This was unsuccessful, and 20 days after presentation, the patient underwent laparotomy. Transverse gastrotomy was performed (Panel C), and a large trichobezoar, forming a cast of the entire stomach, duodenum, and proximal jejunum, was removed en bloc (Panel D). The postoperative course was uneventful, and the patient was discharged on day 10 after surgery and referred to behavioral and mental health providers.
DOI: 10.1056/NEJMicm1403124 Copyright © 2015 Massachusetts Medical Society.
e8
n engl j med 372;6
nejm.org
february 5, 2015
The New England Journal of Medicine Downloaded from nejm.org at OAKLAND UNIVERSITY on May 2, 2015. For personal use only. No other uses without permission. Copyright © 2015 Massachusetts Medical Society. All rights reserved.
n e w e ng l a n d j o u r na l
of
m e dic i n e
images in clinical medicine Lindsey R. Baden, M.D., Editor
Trichobezoar B
A
D
C
Martin Gaillard, M.D. Hadrien Tranchart, M.D. Antoine Béclère Hospital Clamart, France
[email protected]
A
17-year-old girl with a history of autism and trichotillomania presented to the emergency department with vomiting and abdominal pain of 48 hours’ duration. The vital signs and results of a complete blood count and basic metabolic panel were unremarkable. Abdominal computed tomography with intravenous contrast revealed a heterogeneous, meshlike mass extending from the stomach into the duodenum, a finding consistent with a bezoar (Panels A and B, arrowheads). Endoscopic removal of the bezoar was attempted both before and after a 7-day trial of enzymatic dissolution with papain (administered orally as pineapple juice). This was unsuccessful, and 20 days after presentation, the patient underwent laparotomy. Transverse gastrotomy was performed (Panel C), and a large trichobezoar, forming a cast of the entire stomach, duodenum, and proximal jejunum, was removed en bloc (Panel D). The postoperative course was uneventful, and the patient was discharged on day 10 after surgery and referred to behavioral and mental health providers.
DOI: 10.1056/NEJMicm1403124 Copyright © 2015 Massachusetts Medical Society.
e8
n engl j med 372;6
nejm.org
february 5, 2015
The New England Journal of Medicine Downloaded from nejm.org at OAKLAND UNIVERSITY on May 2, 2015. For personal use only. No other uses without permission. Copyright © 2015 Massachusetts Medical Society. All rights reserved.
