A 21 yo female with a history of anxiety presents to the ED with epigastric pain.  She has no associated symptoms. You note on exam patchy baldness and patient chewing on a piece of hair.  Pt reports she sees a therapist for her anxiety and frequent hair pulling and that she sometimes eats the hair.  A CT is shown.  What's the diagnosis?  Scroll down for answer.

Answer: Trichobezoar

• A bezoar is a mass in the GI tract that is formed from the accumulation of a non-absorbable ingestion (trichobezoars are formed from the accumulation of hair)
• Trichotillomania is a psychiatric disorder characterized by recurrent pulling out of hair which causes distress and impairment
• Affects females more than males, onset in early adolescence
• Closely related to obsessive compulsive disorder
• Treated with behavioral therapy

• Estimated that 20% of patients with trichotillomania eat the hair (trichophagia)
• Trichobezoars are often asymptomatic for years but ultimately cause ulcerations (with associated anemia) and obstruction
• Rapunzel syndrome often refers to when a trichobezoar extends through the small bowel and sometimes the colon
• Management requires endoscopy or surgery for removal

References

Grant JE, Chamberlain SR. Trichotillomania. Am J Psychiatry. 2016;173(9):868–874. doi:10.1176/appi.ajp.2016.15111432