Isolated Small Bowel Trichobezoar: A Rare Cause of Intestinal Obstruction in a 4-year-old Child

Abstract

Trichobezoars are rare intraluminal masses composed of ingested hair and are most commonly located in the stomach. Isolated small bowel involvement without gastric extension is particularly uncommon in paediatric patients and may present as acute intestinal obstruction, creating diagnostic difficulty because clinical findings are often non-specific. We report the case of a 4-year-old child with no significant past medical history who was admitted with acute abdominal pain, bilious vomiting that became faecaloid, and complete cessation of stool and flatus for five days. Physical examination revealed abdominal distension, diffuse tenderness, a palpable central abdominal mass, and patchy alopecia suggestive of trichotillomania. Contrast-enhanced computed tomography demonstrated a well-defined, non-enhancing intraluminal small bowel mass with entrapped air bubbles and a mottled or spongiform gas pattern, associated with upstream small bowel dilatation and air–fluid levels. The stomach was free of any intraluminal mass, supporting a diagnosis of isolated small bowel trichobezoar rather than Rapunzel syndrome. Emergency surgical exploration confirmed a firm obstructing small bowel trichobezoar, which was removed through enterotomy. The postoperative course was uneventful, and psychiatric evaluation was recommended to address the underlying behavioural disorder and reduce recurrence risk. This case underlines the value of computed tomography in preoperative diagnosis and timely surgical planning.