OBJECTIVE: Although trichobezoars are well described in the surgical literature, there is relatively little in the psychiatric literature on them. This study aims to focus the attention of readers on trichobezoars by means of a case report and an overview of the literature. METHOD: We present a case of a patient with trichotillomania and a trichobezoar, including psychiatric management. We also briefly review the relevant literature. RESULTS: Hair-pulling significantly improved in response to treatment with the selective serotonin reuptake inhibitor fluoxetine and supportive psychotherapy. CONCLUSIONS: The medical and psychiatric sequelae of trichotillomania should not be underestimated. Pharmacotherapy may be play a useful role in some patients with this disorder.

Trichobezoars in trichotillomania: case report and literature overview.

Hair pulling has been reported in humans, six different non-human primate species, mice, guineapigs, rabbits, sheep and muskox, dogs and cats. This behaviour seems to occur only in subjects who are confined in an artificial environment. It has been classified as a mental disorder in humans, as a behavioural pathology in animals. The hair is not only pulled but also, in most species, ingested. Hair pulling can be both self-directed and partner-directed, contains elements of aggression, manifests more often in females than in males, is associated with psychogenic distress, and resists treatment. Research data collected from affected animals are probably not normative, hence scientifically unreliable. The preemptive correction of husbandry deficiencies causing long-term stress may prevent the development of this bizarre behaviour in healthy subjects.

http://lan.sagepub.com/content/39/4/361.full.pdf

Hair pulling: a review

We report a rare case of giant mesenteric lipoma presenting with colicky abdominal pain A 29-yr-old woman underwent laparoscopic resection for a giant mesenteric lipoma causing compression of the ileal loop The resected ileal segment was encased by a giant fatty tissue, and normal mucosal fold patterns of the resected ileum were effaced by the mass Microscopically, the mass was characterized by homogenous mature adipose tissue without cellular atypia, which was compatible with the diagnosis of a mesenteric lipoma Despite the benign nature of this tumor, total excision with or without the affected intestinal loop should be considered if intestinal symptoms such as abdominal pain are present

/pdf/giant-mesenteric-lipoma-as-an-unusual-cause-of-abdominal-be79j7h1dp.pdf

Giant Mesenteric Lipoma As an Unusual Cause of Abdominal Pain: A Case Report and a Review of the Literature

Bezoars in the stomach and small bowel — CT appearance

A 12-year-old girl presented with midepigastric and right-upper-quadrant abdominal pain of 4 weeks' duration. Often, pain was present in the morning and persisted all day. Occasionally it awakened her at night. Antacids provided temporary relief of pain, but when symptoms persisted, she was referred to a gastroenterologist. There was no nausea, vomiting, hematemesis, or diarrhea. Results of physical examination were normal. However, a small amount of stool that tested positive for occult blood was found on rectal examination. Her hematocrit was 0.35, and results of a complete blood count were within normal limits. An upper gastrointestinal series with air contrast showed thickened gastric folds (Fig 1). Endoscopy of the upper gastrointestinal tract showed diffuse erythema of the gastric mucosa and small petechial hemorrhages in the body of the stomach. The antrum demonstrated fine nodules, and the duodenum was erythematous, with two small ulcerations. Endoscopic biopsy specimens were taken (Figs 2

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=peds&articleId=516281&pdfFileName=archpedi_146_8_029.pdf

Radiological Cases of the Month

Fourteen neonates with posterior mediastinal air collections (retrocardiac pneumomediastinum) are described. In the majority of the infants (13 of 14), the mediastinal air developed as a complication of assisted ventilation. It is suggested that the retrocardiac pneumomediastinum represents air trapped in a potential space in the mediastinum posterior to the heart and not within the pulmonary ligament. The collections have a variable shape and size and rarely may produce a tension phenomenon elevating the posterior, inferior portion of the heart off of the diaphragm. There was a strong association of retrocardiac pneumomediastinum with other manifestations of extraalveolar air, including pulmonary interstitial emphysema (13 of 14 infants), pneumothorax (10 of 14 infants), dissection of air into the soft tissues of the neck (10 of 14 infants), and pneumoperitoneum (5 of 14 infants).

Retrocardiac Pneumomediastinum: Radiographic Finding and Clinical Implications

Spontaneous biliary perforation (SBP) in infancy is rare, with fewer than 140 cases reported to date. The cause of SBP of the extrahepatic biliary system remains unknown. Biliary duct malformation, infection, obstruction, trauma, and other causes have been postulated. We report a case of SBP in a 2-month-old boy with atypical imaging features including a biloma of the lesser sac resembling a gastrointestinal duplication cyst and a false-negative hepatobiliary scan. During surgery, he was found to have a perforation at the junction of the cystic and common ducts that caused a biloma of the lesser sac. To date, this radiologic picture has not been reported.

Spontaneous biliary perforation: biloma resembling a small bowel duplication cyst.

CT diagnosis of a gastric trichobezoar.

Localization of the site of atresia in imperforate anus has classically been carried out by the “upside down” radiograph identifying the blind rectal end, pubic bone, and coccyx on lateral X-rays. This method is often inaccurate because of difficulty in identifying the bony structures and absence of air in the blind rectum. We have studied 6 neonates with CT scans of the pelvis: two males with “high” imperforate anus, one male with a “low” imperforate anus, a female with a cloacal anomaly, a normal stillborn, and a baby with myelomeningocele with a normal anorectum. The CT clearly and accurately identifies all bony structures and pelvic muscle aand determines if bowel is present below the pubococcygeal line, or if it ends above it. In addition, the CT software can generate sagittal and coronal (frontal) reconstructed views from the axial sections to identify the blind rectal end and anus and measure the distance between them. Bowel contents (air and meconium) are distinct other pelvic structures, and CT can muscle and other pelvic structures, and CT can identify these. Identification of the blind pouch by CT is not meant to replace the conventional radiographic evaluations, but may be useful in difficult cases. CT has the potential to identify the level of the blind pouch immediately after birth, without waiting for air to reach the blind rectal end.

Localization of the blind rectal pouch in imperforate anus with the CT scanner

Mesenteric lipoma is a rare benign neoplastic condition that can grow to be very large and mimic other midgut fatty tumors. These benign tumors can cause various gastrointestinal symptoms such as obstruction and abdominal pain. We report the case of a 9-year-old boy who presented with a small bowel obstruction caused by torsion of a large mesenteric lipoma. This is an important but unusual tumor and should be considered in the differential of fatty lesions within the mesentery.

Torsion of a giant mesenteric lipoma.

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