Double Localization Trichobezoar Causing Small Bowel Obstruction in an Adolescent: A Case Report

Abstract

Aims: Trichobezoars are rare, compacted hair masses that most often form in the stomach of young females with trichophagia associated with obsessive-compulsive disorder (OCD). Double localisation—simultaneous gastric and intestinal trichobezoars—is exceedingly rare and poses distinct diagnostic and therapeutic challenges. We report a rare case of a double-localisation trichobezoar causing mechanical small bowel obstruction (SBO), with spontaneous ileal passage followed by elective surgical extraction of the gastric component. Presentation of Case: A 17-year-old female with known OCD and trichophagia and a background of Helicobacter pylori gastritis with iron-deficiency anaemia presented with a one-week history of postprandial vomiting, progressing to a sub-occlusive syndrome with cessation of stools but preserved flatus. Contrast-enhanced CT demonstrated mechanical SBO with calibre disparity at the terminal ileum, consistent with an ileal trichobezoar, and a separate large gastric trichobezoar. Four days after admission, the patient experienced spontaneous passage of the ileal trichobezoar, confirmed by resolution of air-fluid levels on a plain radiograph. The gastric trichobezoar was subsequently treated by elective laparotomy with anterior gastrotomy and en bloc extraction. The postoperative course was uneventful, and psychiatric follow-up for OCD and trichophagia was initiated. Discussion: Trichobezoars almost invariably require surgical intervention; spontaneous intestinal passage is exceptionally rare and has been documented in only a handful of cases worldwide. The coexistence of a gastric trichobezoar mandates vigilance for Rapunzel syndrome and dual-site pathology. CT imaging is the cornerstone of diagnosis and surgical planning in such cases. Conclusion: This case underscores the importance of CT-guided management of double-localisation trichobezoars, highlights the possibility—albeit rare—of spontaneous ileal passage, and reinforces the need for multidisciplinary management, including psychiatric care, to prevent recurrence.