A huge trichobezoar in the jejunum

공장의 모발석 1례

  • Lim, Ho Kyung (Department of Pediatrics, School of Medicine, Chonnam National University) ;
  • Kim, Young Ok (Department of Pediatrics, School of Medicine, Chonnam National University) ;
  • Woo, Young Jong (Department of Pediatrics, School of Medicine, Chonnam National University)
  • 임호경 (전남대학교 의과대학 소아과학교실) ;
  • 김영옥 (전남대학교 의과대학 소아과학교실) ;
  • 우영종 (전남대학교 의과대학 소아과학교실)
  • Received : 2006.01.06
  • Accepted : 2006.01.28
  • Published : 2006.05.15

Abstract

An otherwise healthy, 8-year-old girl presented with vague abdominal pain, vomiting, and a tensely distended abdomen. Abdominal ultrasonography and computed tomography demonstrated a huge amount of jejunal material, about 10 cm long, resulting in near obstruction of the jejunum. The material was removed surgically and a postoperative pathologic report confirmed that it was a trichobezoar. A postoperative consultation with a pediatric psychologist revealed neither abnormal behavioral tendencies nor overt psychopathology. After removing the trichobezoar from the jejunum, her health improved completely. We report a rare case of a huge jejunal trichobezoar in a normally developed child with no psychological problems.

Bezoar는 흡수되지 않은 이물질이 음식물과 섞여 형성된 장내 결석으로 이 중에서도 모발에 의한 경우를 trichobezoar라고 한다. 모발석은 대부분 위 내에 존재하고 소장까지 이동하지는 않는다고 알려져 있으며 빈혈, 위장관 폐쇄 또는 천공, 복막염, 장중첩증, 췌장염 등을 유발할 수 있다. 저자들은 복통과 담즙성 구토를 주소로 내원한 8세 여아에서 공장내의 10 cm 길이의 모발석을 진단하였고, 이로 인해 유발되었을 것으로 추정되는 췌장 효소(아밀라제 및 리파제)의 증가를 관찰하였다. 환아는 모발석의 수술적 제거 후 증상의 호전을 보였고, 췌장효소는 정상화되었다. 드물게 보고되고 있는 공장내의 큰 모발석 1례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

Keywords

References

  1. Williams RS. The fascinating history of bezoars. Med J Aust 1986;145:613-4
  2. Salena BJ, Hunt RH. Bezoar. In : Sleisinger MH, Fordtran JS, editors, Gastrointestinal disease : Pathophysiology/Diagnosis/ Management. Vol 1., 5th ed. Philadelphia : Saunders, 1993:758-63
  3. Andrus CH, Ponsky JL. Bezoars : Classification, pathophysiology and treatment. Am J Gastroenterol 1988;83:476-8
  4. Lee J. Bezoars and foreign bodies of the stomach. Gastrointest Endosc 1996;6:605-19
  5. DeBakey M, Oschner A. Bezoars and concretions, comprehensive review of literature with analysis of 303 collected cases and presentation of 8 additional cases. Surgery 1938; 4:934-63, 1939;5:132-60
  6. Yang UJ, Kong BS, Park SK, Park HJ, Shin MJ, Shin SH. A case of trichobezoar. J Korean Pediatr Soc 1989;5:700-3
  7. Dalshaug GB, Wainer S, Hollaar GL. The Rapunzel syndrome( trichobezoar) causing atypical intussusception in a child : A case report. J Ped Surg 1999;4:479-80
  8. Wadlington WB, Rose M, Holcomb GW Jr. Complications of trichobezoars : a 30-year experience. South Med J 1992; 85:1020-2 https://doi.org/10.1097/00007611-199210000-00024
  9. Vaughan ED Jr, Sawyers JL, Scott HW Jr. The Rapunzel syndrome : An unusual complication of intestinal bezoar. Surgery 1968;63:339-43
  10. West WM, Duncan ND. CT appearance of the Rapunzel syndrome : An unusual form of bezoar and gastrointestinal obstruction. Ped Radiol 1998;28:315-6 https://doi.org/10.1007/s002470050362
  11. Deslypere JP, Preat M, Verdonk G. An unusual case of trichobezoar : The Rapunzel syndrome. Am J Gastroenterol 1982;77:467-70
  12. Wolfson PJ, Fabius RJ, Leibowitz AN. The Rapunzel syndrome : An unusual trichobezoar. Am J Gastroenterol 1987; 82:365-7
  13. Anderson JE, Akmal M, Kittur DS. Surgical complications of pica : Report of a case of intestinal obstruction and a review of the literature. Am Surg 1991;57:663-7
  14. Bhatia MS, Shinghal PK, Rastogi V, Khar N, Nigam VR, Taneja SB. Clinical profile of trichotillomania. J Indian Med Assoc 1991;89:137-9