[Gastro-duodenal trichobezoars: a rare cause of obstruction of the gastrointestinal tract].

Background: Trichobezoars represent 55% of human bezoars. Patients are women in 90% of cases and have some psychiatric disorder in 40%.

Objective: To study the clinical features, diagnostic methodology and treatment in patients with trichobezoars.

Design: Retrospective analysis of clinical records and case report.

Method: Four patients were included between January 2000 and March 2004, 3 women and 1 man, with a mean age of 32.3 years (range 22 to 73 years).

Results: All patients had an epigastric mass, dyspepsia, vomiting, and weight loss of 5 to 25 kg, without pain. Three patients underwent barium studies, and all of them ultrasonography, computerized tomography and upper gastrointestinal endoscopy. All of them received endoscopic procedures without treatment success. Any patient referred trichophagy and all of them had psychiatric disorders. The surgical treatment was gastrotomy and removal of the bezoar. The average weight was 1,100 g (range 700 to 1,500 g).

Conclusions: The trichobezoar is a rare cause of obstruction of the gastrointestinal tract. The diagnosis should be suspected with the clinical and barium study findings, and confirmed by computerized tomography and endoscopy. Surgery is the treatment of choice. However, other treatments have been described, such as endoscopic fragmentation, extracorporeal lithotripsy and laparoscopic extraction.