Trichobezoars(hair ball) are usually located in the stomach, but may extend through the pylorus into the duodenum and small bowel(Rapunzel syndrome). Rapunzel syndrome remains uncommon; with fewer than 40 cases report...Trichobezoars(hair ball) are usually located in the stomach, but may extend through the pylorus into the duodenum and small bowel(Rapunzel syndrome). Rapunzel syndrome remains uncommon; with fewer than 40 cases reported. To the best of our knowledge, this case may be the first well-documented case with a length of 75 cm. They are almost always associated with trichotillomania and trichophagia or other psychiatric disorders. In the literature several treatment options are proposed, including removal by conventional laparotomy, laparoscopy and endoscopy. Herein, we are reporting an interesting case of an 18-year mentally retarded girl with history of trichotillomania and trichophagia who presented to our emergency department with a history of central abdominal pain associated with vomiting and constipation for five days. An examination showed a trichobezoar requiring emergent surgical intervention, and indicating the need for psychiatric treatment. The trichobezoar was treated successfully by laparoscopy.展开更多
Bezoars are usually confined to the stomach which is seen in individuals with psychiatric illness like trichotillomania,trichophagia and gastric dysmotility.Long standing bezoars may extend into the small intestine le...Bezoars are usually confined to the stomach which is seen in individuals with psychiatric illness like trichotillomania,trichophagia and gastric dysmotility.Long standing bezoars may extend into the small intestine leading to a condition known as Rapunzel syndrome.Diagnosis can be established by endoscopy,ultrasonography and computed tomography scan.Treatment includes improvement of general condition and removal of bezoar by laparoscopic approach or laparotomy.Psychiatric consultation is necessary to treat and prevent relapse.We report a case of Rapunzel syndrome in a 16-yearold girl with trichotillomania.She presented with history of epigastric mass for three months and recent onset of pain abdomen,vomiting and early satiety.Skiagram of abdomen was showing distended stomach and endoscopy revealed trichobezoar.At laparotomy,stomach was distended with trichobezoar and there were multiple small intestinal intussusceptions.Gastrotomy and manual reduction of intussusceptions with the removal of trichobezoar with its tail was done.Patient recovered completely after the procedure.展开更多
Celiac disease is a chronic, immune-mediated enteropathy caused by a permanent sensitivity to ingested gluten cereals that develops in genetically susceptible individuals. The classic presentation of celiac disease in...Celiac disease is a chronic, immune-mediated enteropathy caused by a permanent sensitivity to ingested gluten cereals that develops in genetically susceptible individuals. The classic presentation of celiac disease includes symptoms of malabsorption but has long been associated with cognitive, emotional, and behavioral disorders. We describe an 8-year-old patient with nonscarring alopecia and diagnosed with trichotillomania. Furthermore, she presented with a 3-year history of poor appetite and two or three annual episodes of mushy, fatty stools. Laboratory investigations showed a normal hemoglobin concentration and a low ferritin level. Serologic studies showed an elevated tissue immunoglobulin G anti-tissue transglutaminase level. A duodenal biopsy showed subtotal villous atrophy and crypt hyperplasia, and a large gastric trichobezoar was found in the stomach. Immediately after beginning a gluten-free diet, complete relief of trichotillomania and trichophagia was achieved. In this report, we describe a behavioral disorder as a primary phenomenon of celiac disease, irrespective of nutritional status.展开更多
BACKGROUND We report a case of giant gastroduodenal trichobezoar,an extremely rare upper gastrointestinal bezoar due to trichotillomania and trichophagia.CASE SUMMARY The patient was a 10-year-old girl who presented w...BACKGROUND We report a case of giant gastroduodenal trichobezoar,an extremely rare upper gastrointestinal bezoar due to trichotillomania and trichophagia.CASE SUMMARY The patient was a 10-year-old girl who presented with an abdominal mass that was discovered at palpation and noninvasive imaging examinations.Computed tomography(CT)showed a well-circumscribed heterogeneous mass extending from the stomach into the duodenum.The patient underwent a laparotomy to pull out the trichobezoar.Although these imaging findings are nonspecific,trichobezoar should be included in the differential diagnosis of gastric mass,especially with the history of an irresistible urge to pull out and swallow their hair.CONCLUSION Laparotomy is useful and practical for the management of giant gastroduodenal trichobezoar.展开更多
Trichobezoars are an infrequent form of bezoars formed from ingested hair. They are more common in adolescent females with history of trichotillomania. Exceptionally, it can occur in young children making the diagnosi...Trichobezoars are an infrequent form of bezoars formed from ingested hair. They are more common in adolescent females with history of trichotillomania. Exceptionally, it can occur in young children making the diagnosis difficult. We report the case of a 6-year-old girl with a history of abdominal pain, distension, weight loss, and attacks of vomiting. Upper gastrointestinal endoscopy revealed a trichobezoar occupying almost the whole gastric cavity. The gastric bezoar was removed by surgery. Gastric trichobezoar is exceptional in young children and can lead to stunting and gastric outlet obstruction. After definitive surgical or endoscopic treatment, pediatric psychiatric consultation should be opted for any mental disorder and for prevention of further recurrence.展开更多
Background: Many skin diseases can be evoked by psychological problems. Dermatological conditions could also lead to psychological disorders;hence psychodermatology is an emerging subspecialty that focuses on the inte...Background: Many skin diseases can be evoked by psychological problems. Dermatological conditions could also lead to psychological disorders;hence psychodermatology is an emerging subspecialty that focuses on the interface of psychiatry and dermatology. Objective: To assess the frequency of the major disorders of so-called psychocutaneous disorders which are commonly seen among Iraqi population. Patients and Methods: This case descriptive study had been done in Department of Dermatology-Baghdad Teaching Hospital, Medical City, Baghdad, Iraq during the period from March 2011 to October 2013. All cases were collected and categorized according to the disease problem. Patients were interviewed to search for the main triggering and precipitating factors involved in pathogenesis of these disorders. The clinical picture was well described in order to reach a final diagnosis. Psychological interview and analysis were performed for all patients to reach the specific emotional and psychiatric disease by consultant psychiatrist. Results: A total of 100 patients with major psychocutaneous disorders were seen and evaluated. Nineteen were males and 81 were females with female to male ratio: 4.26:1. Their ages ranged from 7 - 73 (26.5 ± 5.217) years. The frequency of these diseases was as follows: trichotillomania 53%, dermatitis artifacta 37%, delusion of parasitosis 6% and neurotic excoriation 4%. Conclusions: The major psychocutaneous diseases in Iraqi population were: trichotillomania, dermatitis artifacta and these are problems of mainly young females while delusion of parasitosis and neurotic excoriations were diseases of middle age females.展开更多
Trichobezoars are accumulations of hair casts in the stomach which is associated with trichophagia. The continuous ingestion causes mass of undigested material within the gastrointestinal, accumulating between the muc...Trichobezoars are accumulations of hair casts in the stomach which is associated with trichophagia. The continuous ingestion causes mass of undigested material within the gastrointestinal, accumulating between the mucosal folds of stomach. Trichotillomania, is a mental disorder, described when someone cannot resist the urge to pull their hair from the scalp, eyebrows or eyelashes seen generally by teenagers or adolescents. A person with trichotillomania may experience repetitive pulling of hair, often without awareness, associated with anxiety and a sense of relief after pulling out hair. Consumed hair strands are beyond the pylorus into the small bowel identified as Rapunzel syndrome. Two cases of trichobezoars were encountered in our centre. They presented with nonspecific abdominal pain and abdominal mass. After investigations, with clinical correlation they were subjected to surgery, an open gastrotomy and complete removal of the trichobezoars. After surgery, the aim is to prevent recurrence by tackling the underlying cause of trichophagia which is commonly associated with trichotillomania. This case report series discusses about the management of trichobezoars.展开更多
Hair loss is one of the most common complaints among all patients consulting a dermatologist and is usually associated with severe psychological disturbances, distress and symptoms of depression. [1-3]. It can be temp...Hair loss is one of the most common complaints among all patients consulting a dermatologist and is usually associated with severe psychological disturbances, distress and symptoms of depression. [1-3]. It can be temporary or long lasting. Diagnosis of hair loss is based on detailed clinical history, physical exam, clinical diagnostic tests, laboratory testing, and scalp biopsy, which may be necessary to confirm some diagnoses. This article presents an overview of the most common clinical causes of hair loss and provides updated information on the current available therapeutic options for these disorders.展开更多
文摘Trichobezoars(hair ball) are usually located in the stomach, but may extend through the pylorus into the duodenum and small bowel(Rapunzel syndrome). Rapunzel syndrome remains uncommon; with fewer than 40 cases reported. To the best of our knowledge, this case may be the first well-documented case with a length of 75 cm. They are almost always associated with trichotillomania and trichophagia or other psychiatric disorders. In the literature several treatment options are proposed, including removal by conventional laparotomy, laparoscopy and endoscopy. Herein, we are reporting an interesting case of an 18-year mentally retarded girl with history of trichotillomania and trichophagia who presented to our emergency department with a history of central abdominal pain associated with vomiting and constipation for five days. An examination showed a trichobezoar requiring emergent surgical intervention, and indicating the need for psychiatric treatment. The trichobezoar was treated successfully by laparoscopy.
文摘Bezoars are usually confined to the stomach which is seen in individuals with psychiatric illness like trichotillomania,trichophagia and gastric dysmotility.Long standing bezoars may extend into the small intestine leading to a condition known as Rapunzel syndrome.Diagnosis can be established by endoscopy,ultrasonography and computed tomography scan.Treatment includes improvement of general condition and removal of bezoar by laparoscopic approach or laparotomy.Psychiatric consultation is necessary to treat and prevent relapse.We report a case of Rapunzel syndrome in a 16-yearold girl with trichotillomania.She presented with history of epigastric mass for three months and recent onset of pain abdomen,vomiting and early satiety.Skiagram of abdomen was showing distended stomach and endoscopy revealed trichobezoar.At laparotomy,stomach was distended with trichobezoar and there were multiple small intestinal intussusceptions.Gastrotomy and manual reduction of intussusceptions with the removal of trichobezoar with its tail was done.Patient recovered completely after the procedure.
文摘Celiac disease is a chronic, immune-mediated enteropathy caused by a permanent sensitivity to ingested gluten cereals that develops in genetically susceptible individuals. The classic presentation of celiac disease includes symptoms of malabsorption but has long been associated with cognitive, emotional, and behavioral disorders. We describe an 8-year-old patient with nonscarring alopecia and diagnosed with trichotillomania. Furthermore, she presented with a 3-year history of poor appetite and two or three annual episodes of mushy, fatty stools. Laboratory investigations showed a normal hemoglobin concentration and a low ferritin level. Serologic studies showed an elevated tissue immunoglobulin G anti-tissue transglutaminase level. A duodenal biopsy showed subtotal villous atrophy and crypt hyperplasia, and a large gastric trichobezoar was found in the stomach. Immediately after beginning a gluten-free diet, complete relief of trichotillomania and trichophagia was achieved. In this report, we describe a behavioral disorder as a primary phenomenon of celiac disease, irrespective of nutritional status.
文摘BACKGROUND We report a case of giant gastroduodenal trichobezoar,an extremely rare upper gastrointestinal bezoar due to trichotillomania and trichophagia.CASE SUMMARY The patient was a 10-year-old girl who presented with an abdominal mass that was discovered at palpation and noninvasive imaging examinations.Computed tomography(CT)showed a well-circumscribed heterogeneous mass extending from the stomach into the duodenum.The patient underwent a laparotomy to pull out the trichobezoar.Although these imaging findings are nonspecific,trichobezoar should be included in the differential diagnosis of gastric mass,especially with the history of an irresistible urge to pull out and swallow their hair.CONCLUSION Laparotomy is useful and practical for the management of giant gastroduodenal trichobezoar.
文摘Trichobezoars are an infrequent form of bezoars formed from ingested hair. They are more common in adolescent females with history of trichotillomania. Exceptionally, it can occur in young children making the diagnosis difficult. We report the case of a 6-year-old girl with a history of abdominal pain, distension, weight loss, and attacks of vomiting. Upper gastrointestinal endoscopy revealed a trichobezoar occupying almost the whole gastric cavity. The gastric bezoar was removed by surgery. Gastric trichobezoar is exceptional in young children and can lead to stunting and gastric outlet obstruction. After definitive surgical or endoscopic treatment, pediatric psychiatric consultation should be opted for any mental disorder and for prevention of further recurrence.
文摘Background: Many skin diseases can be evoked by psychological problems. Dermatological conditions could also lead to psychological disorders;hence psychodermatology is an emerging subspecialty that focuses on the interface of psychiatry and dermatology. Objective: To assess the frequency of the major disorders of so-called psychocutaneous disorders which are commonly seen among Iraqi population. Patients and Methods: This case descriptive study had been done in Department of Dermatology-Baghdad Teaching Hospital, Medical City, Baghdad, Iraq during the period from March 2011 to October 2013. All cases were collected and categorized according to the disease problem. Patients were interviewed to search for the main triggering and precipitating factors involved in pathogenesis of these disorders. The clinical picture was well described in order to reach a final diagnosis. Psychological interview and analysis were performed for all patients to reach the specific emotional and psychiatric disease by consultant psychiatrist. Results: A total of 100 patients with major psychocutaneous disorders were seen and evaluated. Nineteen were males and 81 were females with female to male ratio: 4.26:1. Their ages ranged from 7 - 73 (26.5 ± 5.217) years. The frequency of these diseases was as follows: trichotillomania 53%, dermatitis artifacta 37%, delusion of parasitosis 6% and neurotic excoriation 4%. Conclusions: The major psychocutaneous diseases in Iraqi population were: trichotillomania, dermatitis artifacta and these are problems of mainly young females while delusion of parasitosis and neurotic excoriations were diseases of middle age females.
文摘Trichobezoars are accumulations of hair casts in the stomach which is associated with trichophagia. The continuous ingestion causes mass of undigested material within the gastrointestinal, accumulating between the mucosal folds of stomach. Trichotillomania, is a mental disorder, described when someone cannot resist the urge to pull their hair from the scalp, eyebrows or eyelashes seen generally by teenagers or adolescents. A person with trichotillomania may experience repetitive pulling of hair, often without awareness, associated with anxiety and a sense of relief after pulling out hair. Consumed hair strands are beyond the pylorus into the small bowel identified as Rapunzel syndrome. Two cases of trichobezoars were encountered in our centre. They presented with nonspecific abdominal pain and abdominal mass. After investigations, with clinical correlation they were subjected to surgery, an open gastrotomy and complete removal of the trichobezoars. After surgery, the aim is to prevent recurrence by tackling the underlying cause of trichophagia which is commonly associated with trichotillomania. This case report series discusses about the management of trichobezoars.
文摘Hair loss is one of the most common complaints among all patients consulting a dermatologist and is usually associated with severe psychological disturbances, distress and symptoms of depression. [1-3]. It can be temporary or long lasting. Diagnosis of hair loss is based on detailed clinical history, physical exam, clinical diagnostic tests, laboratory testing, and scalp biopsy, which may be necessary to confirm some diagnoses. This article presents an overview of the most common clinical causes of hair loss and provides updated information on the current available therapeutic options for these disorders.
