RESUMEN
Introducción. El síndrome de Rapunzel es una entidad infrecuente, que se presenta como un tricobezoar a causa de una aglomeración de cabello acumulado dentro del tracto gastrointestinal, por lo que simula otras patologías quirúrgicas. Caso clínico. Paciente femenina de 10 años de edad, con tricotilomanía y tricofagia, dolor abdominal y síntomas inespecíficos de obstrucción intestinal de ocho meses de evolución. Al examen físico se encontró abdomen con distensión y masa palpable en epigastrio y mesogastrio. La ecografía permitió hacer el diagnóstico de tricobezoar gástrico extendido hasta el intestino delgado, por lo que se llevó a cirugía para gastrotomía y se extrajo el tricobezoar, con evolución satisfactoria de la paciente. El abordaje integral permitió conocer la atadura sicológica por posible maltrato infantil. Resultado. La paciente tuvo una evolución satisfactoria y se dio egreso al quinto día de hospitalización. Actualmente se encuentra en seguimiento por sicología, siquiatría infantil y pediatría. Discusión. El caso clínico denota la importancia en reconocer situaciones de presentación infrecuente en pediatría, que puedan estar asociadas a alteraciones sicológicas o presunción de maltrato infantil y que se presenten como una condición orgánica recurrente que simule otras patologías abdominales frecuentes en la infancia. El retraso diagnóstico puede conducir a un desenlace no deseado con complicaciones. Conclusión. Se hace mandatorio el manejo integral del paciente pediátrico y aumentar la sensibilidad para reconocer situaciones de presunción de maltrato infantil, sobre todo en pacientes con una condición orgánica quirúrgica recurrente.
Introduction. Rapunzel syndrome is an uncommon condition that manifests as trichobezoars, which are hair bundles in the stomach or small intestine that can mimics other surgical illnesses. Multiple complications can arise from delayed diagnosis and treatment. Clinical case. A 10-year-old female patient with trichotillomania and trichophagia, with abdominal pain and nonspecific symptoms of intestinal obstruction of eight months of evolution. Physical examination revealed epigastric tenderness and a solid mass was palpable in the mesogastric and epigastric region. An abdominal ultrasound showed gastric trichobezoar that extended into the small intestine. A gastrotomy was performed and the trichobezoar was extracted with satisfactory evolution of the patient. The comprehensive approach allowed knowing the psychological bond due to possible child abuse. Results. The patient had a satisfactory evolution and was discharged on the fifth day of hospitalization. He is currently being monitored by psychology, child psychiatry and pediatrics. Discussion. This clinical case highlights the importance of recognizing situations that seldom present in pediatrics, which may have a psychological aspect due to the presumption of child abuse, and which present as a recurrent organic condition simulating other frequent abdominal pathologies in childhood; all of which may lead to an unwanted outcome due to diagnostic delay. Conclusion. The comprehensive management of the pediatric patient is mandatory to recognize situations of presumed child abuse, in the face of a recurrent surgical conditions.
Asunto(s)
Humanos , Tricotilomanía , Bezoares , Obstrucción Duodenal , Estómago , Psiquiatría Infantil , Diagnóstico DiferencialRESUMEN
Background: Rapunzel syndrome is a rare presentation of trichobezoar, secondary to the ingestion of hair known as trichophagia. This bezoar has been found mainly in women, it invades the stomach and extends to the small intestine. Clinically, patients present weight loss and chronic obstructive symptoms at the intestinal level. A case of Rapunzel syndrome is presented. Clinical case: A 13-year-old female presented with a weight loss of 10kg in two months, chronic constipation, predominantly nocturnal vomiting, and abdominal pain of seven days' duration. Physical examination revealed decreased peristalsis and a palpable mass in the epigastrium. Laboratories taken on admission: normal blood count, kidney function tests, and liver function tests. The abdominal X-ray showed opacity in the fundus, body and gastric antrum, the abdominal ultrasound showed non-specific findings in the epigastrium, later an abdominal tomography was performed with a swallow of water-soluble contrast medium and showed occupation in the gastric lumen. She underwent exploratory laparotomy and the finding was a trichobezoar in the stomach with extension to the duodenum and part of the jejunum, which was removed without complications. The evolution of the patient was favorable. Conclusions: For the diagnosis of Rapunzel Syndrome, the use of contrast imaging studies is necessary, and the treatment of choice is surgical.
Introducción: el síndrome de Rapunzel es una presentación poco frecuente de tricobezoar, secundario a la ingesta de cabello conocida como tricofagia. Este bezoar se ha encontrado principalmente en mujeres, invade estómago y se extiende a intestino delgado. Clínicamente, los pacientes presentan pérdida de peso y síntomas crónicos de tipo obstructivo a nivel intestinal. Se presenta un caso de síndrome de Rapunzel. Caso clínico: paciente mujer de 13 años que se presenta con pérdida de peso de 10 kg en dos meses, estreñimiento crónico, vómito de predominio nocturno y dolor abdominal de siete días de evolución. A la exploración física, se encontró peristalsis disminuida y masa palpable en epigastrio. Laboratorios tomados a su ingreso: biometría hemática, pruebas de función renal y hepáticas normales. La radiografía de abdomen mostró opacidad en fundus, cuerpo y antro gástrico, la ecografía de abdomen mostró hallazgos inespecíficos en epigastrio, posteriormente se realizó tomografía abdominal con trago de medio de contraste hidrosoluble y mostró ocupación en la luz gástrica. Se sometió a laparotomía exploradora y el hallazgo fue un tricobezoar en estómago con extensión a duodeno y parte de yeyuno, fue removido sin complicaciones. La evolución de la paciente fue favorable. Conclusiones: para el diagnóstico del síndrome de Rapunzel es necesario el uso de estudios de imagen contrastados y el tratamiento de elección es quirúrgico.
Asunto(s)
Bezoares , Tricotilomanía , Humanos , Femenino , Adolescente , Bezoares/diagnóstico por imagen , Bezoares/complicaciones , Tricotilomanía/complicaciones , Estómago , Cabello , Tomografía Computarizada por Rayos X , SíndromeRESUMEN
Introducción. Los tricobezoares ocurren de forma frecuente en niñas y adolescentes, y se asocian a trastornos psicológicos como depresión, tricotilomanía o tricofagia. Caso clínico. Se presenta una paciente adolescente con síndrome de Rapunzel, con hallazgo adicional de perforación yeyunal debido al tricobezoar. Discusión. Dentro de las complicaciones de los tricobezoares se reporta invaginación intestinal (principalmente de yeyuno), apendicitis, obstrucción biliar, neumonía, pancreatitis secundaria y perforación, esta última como ocurrió en nuestra paciente. Conclusión. En pacientes mujeres adolescentes con dolor abdominal o abdomen agudo, se debe tener en cuenta el diagnóstico de síndrome de Rapunzel, así como sus probables complicaciones
Introduction. Trichobezoars occur frequently in young and adolescent girls, and are associated with psychological disorders such as depression, trichotillomania, or trichophagia. Clinical case. An adolescent patient with Rapunzel syndrome is presented, with an additional finding of jejunal perforation due to the trichobezoar. Discussion. Among the complications of trichobezoars, intussusception is reported (mainly of the jejunum), appendicitis, biliary obstruction, pneumonia, secondary pancreatitis, and perforation, the latter as occurred in our patient. Conclusion. In adolescent female patients with abdominal pain or acute abdomen, the diagnosis of Rapunzel syndrome should be taken into account, as well as its probable complications
Asunto(s)
Humanos , Tricotilomanía , Bezoares , Perforación Intestinal , Síndrome , Abdomen Agudo , LaparotomíaRESUMEN
El tricobezoar es una masa no digerible de cabellos con restos alimenticios entre otros, que forman concreciones. Se presenta el caso de una adolescente de 15 años de edad con un cuadro clínico de más o menos 2 años de evolución, caracterizado por disminución de peso, se reagudiza hace 2 semanas con nauseas que llegan al vomito. Llega a nuestro servicio, donde se le realiza una tomografía abdominal y una endoscopia, confirmando el diagnostico de tricobezoar gastroduodenal. Se interna a la paciente para manejo nutricional y es intervenida quirúrgicamente. Como hallazgo intraoperatorio se evidencio una ulcera en cara posterior del estómago. Se realizo un manejo conjunto con psiquiatría y nutrición. Se le dio de alta al noveno día postoperatorio, con una evolución favorable, con un control laboratorial más aceptable y con el aumento de 2 kilos. El manejo de estos pacientes debe ser multidisciplinario, buscando que el cuadro no recidive
The trichobezoar is a non-digestible mass of hair with food debris among others, forming concretions. We present the case of a 15-year-old adolescent with a clinical picture of more or less 2 years of evolution, characterized by weight loss, exacerbated 2 weeks ago with nausea and vomiting. She arrives at department, where an abdominal tomography and an endoscopy are performed, confirming the diagnosis of gastroduodenal trichobezoar. The patient was admitted for nutritional management and underwent surgery. Intraoperative findings shower an ulcer in the posterior aspect of the stomach. A joint management with psychiatry and nutrition was performed. She was discharged on the ninth postoperative day, with a favorable evolution, with a more acceptable laboratory control and with an increase of 2 kilos. The management of these patients should be multidisciplinary, ensuring that the condition does not relapse
RESUMEN
Un tricobezoar es una masa compacta de pelo que se aloja generalmente en el estómago. Es frecuente en mujeres jóvenes que comen su propio pelo (tricofagia) debido a trastornos psicológicos. Presentamos el caso de una adolescente de 13 años de edad quien es traída por emergencia por presentar dolor abdominal persistente desde hace 3 días. La ecografía abdominal fue sugestiva de tricobezoar, hallazgo que fue confirmado mediante una endoscopia digestiva alta. Desde hace dos años antes de su ingreso, presentaba, masticación de cabello y consumo del mismo que asocia a viaje de su hermano al extranjero y a la separación de sus padres. Al noveno día, se realizó laparotomía exploratoria con gastrostomía extrayendo tricobezoar gástrico, que en el estudio anatomopatológico pesó 1033,8 g y midió 31,5 x 18 cm. en sus dimensiones mayores. Estos casos son sumamente raros. En nuestro caso el tricobezoar alcanzó el tamaño más grande de los hasta ahora reportados. Contradictoriamente la sintomatología fue mínima.
A trichobezoar is a compact mass of hair that is usually stored in the stomach. It is common in young women who eat their own hair (trichophagia) due to psychological disorders. We present the case of a 13-year-old teenager who had been brought in an emergency for having persistent abdominal pain for 3 days. Abdominal ultrasound was suggestive of trichobezoar, a finding that was confirmed by upper gastrointestinal endoscopy. For two years before her admission, she had chewed her hair and consumed it, which she associated with her brother's trip abroad and the separation of her parents. On the ninth day, an exploratory laparotomy with gastrostomy was performed, extracting gastric trichobezoar, which in the anatomopathological study weighed 1033.8 g. and measured 31.5 x 18 cm. in its larger dimensions. These cases are extremely rare. In our case, the trichobezoar reached the largest size of those reported so far. Contradictorily, the symptoms were minimal.
RESUMEN
Resumen El tricobezoar es una variedad de los bezoarios cuya característica es la presencia de una masa compacta constituida por material no digerible, principalmente cabellos y otros componentes. Presentación de casos: Se presentan 2 casos de pacientes de 4 y 9 años, quienes ingresaron por emergencias, con evolución clínica crónica caracterizada por una masa abdominal palpable, pérdida de peso progresiva asociada a tricofagia-tricotilomania, con presunción diagnóstica de ingreso de bezoar gástrico. La ecografía abdominal en ambos pacientes reportó imagen ecorefringente en su interior que produce sombra acústica, compatible con probable tricobezoar, diagnóstico reforzado por tomografía computarizada con contraste. Dada la imposibilidad de extracción vía endoscópica por el gran tamaño, se optó por realizar laparotomía exploratoria, extrayéndose en los 2 casos la masa en bloque completa a través de una gastrotomía. Las pacientes presentaron una evolución favorable, recibiendo alimentación parenteral por 5 días y luego ingesta oral con buena tolerancia, dando de alta hospitalaria a su 9° y 10° día postoperatorio, con seguimiento interdisciplinario y apoyo psicológico. Debe considerarse como primera posibilidad diagnóstica el tricobezoar ante presencia de tricotilomanía, compromiso afectivo, retraso psicomotor, clínica intestinal. En estos casos el manejo neuropsiquiátrico postquirúrgico es fundamental a fin de reducir el riesgo de recurrencias.
Abstract The trichobezoar is a variety of bezoars whose characteristic is the presence of a compact mass made up of indigestible material, mainly hair and other components. Presentation of cases: We present 2 cases of patients aged 4 and 9 years, who were admitted to an emergency room, with symptoms of chronic evolution characterized by a palpable abdominal mass, progressive weight loss associated with trichophagia-trichotillomania, with presumed diagnosis of gastric bezoar admission. The abdominal ultrasound in both reported an echorefringent image inside that produces an acoustic shadow, compatible with a probable trichobezoar, a diagnosis reinforced by contrast-enhanced computed tomography. Given the impossibility of endoscopic extraction due to the large size, it was decided to perform exploratory laparotomy, extracting the complete en-bloc mass through a gastrotomy in both cases. The patients presented a favorable evolution, receiving parenteral feeding for 5 days and then oral ingestion with good tolerance, being discharged from hospital on their 9th and 10th postoperative day with interdisciplinary follow-up and psychological support. There is a high suspicion of trichobezoar in the presence of trichotillomania, affective compromise, psychomotor retardation, intestinal symptoms and postsurgical neuropsychiatric management is essential in order to reduce the risk of recurrence.
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Resumen El barbering es una conducta que consiste en halar o recortar el pelo y en algunos casos incluso ingerirlo. Este comportamiento ha sido reportado tanto en el ser humano como en otras especies, no obstante, su presentación en ratones de laboratorio es frecuente en algunos linajes, genera impacto sobre su bienestar y la fiabilidad de los resultados de investigación, siendo un problema destacado en los bioterios de ratones. Al realizar una revisión de literatura disponible sobre esta condición, se identifican múltiples causas, entre estas, deficiencias en el enriquecimiento ambiental, alteraciones de manejo, estrés, conductas aprendidas, ansiedad y dominancia, así como causas genéticas haciendo que algunas cepas, linajes y modelos genéticamente modificados sean más susceptibles al barbering y ayudando a facilitar la comprensión de rutas metabólicas involucradas en esta condición. La etiología múltiple del barbering permite abordar opciones de manejo orientadas hacia la intervención ambiental y algunas estrategias farmacológicas que podrían ser útiles para reducir su incidencia y los problemas de salud y desempeño reproductivo asociados.
Abstract Barbering is a behavior that consists of pulling, cutting, or even ingesting hair. This behavior has been reported in humans or other animals; nevertheless, its presentation in laboratory mice is common in some mice strains, affects these animals' welfare, and results of research studies being a problem in mice facilities. After reviewing the available literature on this condition, multiple causes are identified, including deficiencies in environmental enrichment, management alterations, stress, learned behaviors, anxiety, and dominance, as well as genetic causes, making some strains, lineages, and genetically modified models more susceptible to barbering and helping to facilitate the understanding of metabolic pathways involved in this condition. The multiple etiology of barbering makes it possible to approach management options oriented towards environmental intervention and some pharmacological strategies that could be useful to reduce its incidence and associated reproductive health and performance problems.
Resumo O comportamento de barbeiro consiste em puxar ou aparar o pelo e, em alguns casos, até mesmo ingeri-lo. Esse comportamento tem sido relatado tanto em humanos quanto em outras espécies, entretanto, sua apresentação em camundongos de laboratório é frequente em algumas linhagens, gerando impacto no seu bem-estar e na confiabilidade dos resultados das pesquisas, sendo um problema de destaque nos biotérios. Ao realizar uma revisão da literatura disponível sobre esta condição, múltiplas causas foram identificadas, incluindo deficiências no enriquecimento ambiental, alterações de manejo, estresse, comportamentos aprendidos, ansiedade e dominância, além de causas genéticas, tornando mais suscetíveis à barbearia à algumas linhagens e modelos geneticamente modificados e ajudando a facilitar o entendimento das vias metabólicas envolvidas nessa condição. A múltipla etiologia deste comportamento de barbeiro permite abordar opções de gestão orientadas para a intervenção ambiental e algumas estratégias farmacológicas que podem ser úteis para reduzir a sua incidência e os problemas de saúde e desempenho reprodutivos associados.
RESUMEN
El bezoar gástrico es una tumoración por cuerpo extraño que resulta de la acumulación de material no digerible en el estómago. El tricobezoar es uno de ellos y frecuentemente se presenta en la población femenina joven que padece trastornos psiquiátricos. La presentación del bezoar gástrico es insidiosa e inespecífica, teniendo un curso inicialmente asintomático por años, hasta que alcanza un tamaño que evidencia síntomas. El método diagnóstico de elección es la endoscopía, ya que permite visualizar el bezoar y plantear el tratamiento. El abordaje terapéutico estará determinado por el tipo, tamaño y consistencia de este; sin embargo, la resolución quirúrgica es la de elección, la cual siempre debe estar asociada a tratamiento psiquiátrico para prevenir la recurrencia del cuadro. Se presenta el caso de una paciente de 19 años con el diagnóstico de tricobezoar gástrico, asociado a tricotilomanía y tricofagia como patologías de fondo, y se realiza una revisión de la literatura.
A gastric bezoar is a foreign body tumor that results from the accumulation of indigestible material in the stomach. The trichobezoar is one of them and frequently occurs in the young female population suffering from psychiatric disorders. The presentation of the gastric bezoar is insidious and nonspecific, having an initially asymptomatic course for years, until it reaches a size that shows symptoms. The diagnostic method of choice is endoscopy since it allows the bezoar to be visualized and propose the treatment. The therapeutic approach will be determined by its type, size, and consistency; however, surgical resolution is the one of choice, which must always be associated with psychiatric treatment to prevent recurrence of the condition. The case of a 19-year-old patient with a diagnosis of gastric trichobezoar, associated with trichotillomania and trichophagia as underlying pathologies is presented, and a literature review is carried out.
RESUMEN
Introducción: La tricotilomania, la tricofagia y el tricobezoar son afecciones entrelazadas e interconectadas. Estas deben tenerse en cuenta especialmente en féminas jóvenes que a menudo tienen una enfermedad psiquiátrica o trastorno social subyacente y es posible que la historia sea difícil de obtener. Objetivo: Presentar un caso portador de tricobezoar gástrico, por su baja incidencia en nuestro medio y a nivel mundial. Caso clínico: Paciente femenina de 12 años de edad, con antecedentes de retraso psicomotor, sin seguimiento o tratamiento previo. Acudió a consulta traída por su madre que aduce aumento de volumen en hemiabdomen superior de 5 años de evolución con pérdida de peso insidiosa. Los estudios radiológicos revelaron un tricobezoar gástrico que se corrobora, asociado a un síndrome de Rapunzel, en la laparotomía exploratoria. La paciente evolucionó satisfactoriamente y es seguida por grupo multidisciplinario. Conclusiones: Los bezoares gástricos son entidades poco frecuentes. Para el diagnóstico es necesario un alto índice de sospecha de conjunto con estudios radiográficos y/o endoscópicos. El tratamiento estará determinado por el tipo de bezoar, tamaño y consistencia. La opción quirúrgica es la más usada, con el consecuente seguimiento interdisciplinario para evitar recurrencias(AU)
Introduction: Trichotillomania, trichophagia and trichobezoar are intertwined and interconnected conditions. These should be considered, especially in young women who often have an underlying psychiatric illness or social disorder and possibly a history difficult to get. Objective: To report a case of gastric trichobezoar due to its low incidence in our environment and worldwide. Clinical case report: We report the case of a 12-year-old female patient with a history of psychomotor retardation, with no prior follow-up or treatment, who came to consult with her mother, complaining of increased volume in the upper abdomen, of 5 years of evolution with malignant weight loss. Radiological studies reveal a gastric trichobezoar that is corroborated, associated with Rapunzel syndrome, in the exploratory laparotomy. The patient evolved satisfactorily and a multidisciplinary group assisted her. Conclusions: Gastric bezoars are rare entities. Diagnosis requires high level of suspicion together with radiographic and/or endoscopic studies. The treatment will be determined by the type of bezoar, size and consistency. The surgical option is the most used, requiring interdisciplinary follow-up to avoid recurrences(AU)
Asunto(s)
Humanos , Tricotilomanía , Bezoares/diagnóstico , Trastornos Mentales , Informe de Investigación , Laparotomía/métodosRESUMEN
Trichotillomania is the most frequent reported cause of self-inflicted hair disorders, within which are included trichoteiromania, trichotemnomania, and trichocryptomania, also known as trichorrexomania. These conditions are commonly described in the context of psychiatric disorders. Nevertheless, there exists reports in otherwise healthy patients that suffer a form of no cicatricial alopecia, such as alopecia areata. We communicate 3 cases of male androgenetic alopecia with patterned miniaturization that coexisted with trichoscopic findings of trichoteiromania. The presence of brush-like ends or broom hairs is a highly suggestive feature of this entity. To the best of our knowledge, this association was not previously reported in the medical literature. The possibility of self-induced hair loss should be kept in mind during every follow-up visit in all types of alopecia, remembering that hair loss itself is already a distressing condition.
RESUMEN
Alopecia areta (AA) and trichotillomania (TTM) are common causes for hair loss on the eyebrows. Yellow dots, vellus hairs, anisotrichosis, empty follicular openings, and black dots were observed in the present study's patients with AA. Split hairs, question mark hairs, broken hairs, flame hairs, black dots, hairs with different lengths, and hemorrhagic areas were found in the patients with TTM. Trichoscopy is a very useful and helpful technic in distinguishing AA and TTM on the eyebrows.
Asunto(s)
Alopecia Areata , Tricotilomanía , Dermoscopía , Cejas , Cabello/diagnóstico por imagen , Humanos , Tricotilomanía/complicacionesRESUMEN
Trichotillomania is defined as an obsessive-compulsive or related disorder in which patients recurrently pull out hair from any region of their body. The disease affects mainly female patients, who often deny the habit, and it usually presents with a bizarre pattern nonscarring patchy alopecia with short hair and a negative pull test. Trichoscopy can reveal the abnormalities resulting from the stretching and fracture of hair shafts, and biopsy can be necessary if the patient or parents have difficulties in accepting the self-inflicted nature of a trichotillomania diagnosis. Trichotillomania requires a comprehensive treatment plan and interdisciplinary approach. Physicians should always have a nonjudgmental, empathic, and inviting attitude toward the patient. Behavioral therapy has been used with success in the treatment of trichotillomania, but not all patients are willing or able to comply with this treatment strategy. Pharmacotherapy can be necessary, especially in adolescents and adult patients. Options include tricyclic antidepressants, selective serotonin reuptake inhibitors, and glutamate-modulating agents. Glutamate-modulating agents such as N-acetylcysteine are a good first-line option due to significant benefits and low risk of side effects. Physicians must emphasize that the role of psychiatry-dermatology liaison is extremely necessary with concurrent support services for the patient and parents, in case of pediatric patients. In pediatric cases, parents should be advised and thoroughly educated that negative feedback and punishment for hair pulling are not going to produce positive results. Social support is a significant pillar to successful habit reversal training; therefore, physicians must convey the importance of familial support to achieving remission. This is a review article that aims to discuss the literature on trichotillomania, addressing etiology, historical aspects, clinical and trichoscopic features, main variants, differential diagnosis, diagnostic clues, and psychological and pharmacological management.
RESUMEN
Abstract Alopecia areta (AA) and trichotillomania (TTM) are common causes for hair loss on the eyebrows. Yellow dots, vellus hairs, anisotrichosis, empty follicular openings, and black dots were observed in the present study's patients with AA. Split hairs, question mark hairs, broken hairs, flame hairs, black dots, hairs with different lengths, and hemorrhagic areas were found in the patients with TTM. Trichoscopy is a very useful and helpful technic in distinguishing AA and TTM on the eyebrows.
RESUMEN
BACKGROUND: Rapunzel syndrome is the formation of a trichobezoar that extends beyond the small intestine. Since its discovery few cases have been reported in the literature with variable clinical characteristics, causing important complications such as intestinal obstruction. Laparotomy is currently considered the treatment of choice. CASE REPORT: We present the clinical case of a patient who presented with recurrent peritonitis associated with a peritoneal dialysis catheter, anorexia, nausea, vomiting, without channeling or presenting evacuations, epigastric tumor, anxiety, trichotillomania and trichophagia. Rapunzel syndrome is diagnosed and admission to the operating room is decided.
ANTECEDENTES: El síndrome de Rapunzel es la formación de un tricobezoar que se extiende más allá del intestino delgado. Desde su descubrimiento, pocos casos se han reportado en la literatura y con características clínicas variables, provocando complicaciones importantes como obstrucción intestinal. Actualmente, la laparotomía se considera el tratamiento de elección. CASO CLÍNICO: Paciente de sexo femenino que acude por presentar peritonitis de repetición asociada a catéter de diálisis peritoneal, anorexia, náuseas, vómito, sin canalizar ni presentar evacuaciones, tumoración en epigastrio, ansiedad, tricotilomanía y tricofagia. Se realiza el diagnóstico de síndrome de Rapunzel y se decide su ingreso a quirófano.
Asunto(s)
Bezoares , Obstrucción Intestinal , Tricotilomanía , Bezoares/complicaciones , Bezoares/diagnóstico por imagen , Bezoares/cirugía , Humanos , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Intestino Delgado , Estómago , Tricotilomanía/complicacionesRESUMEN
RESUMEN Fundamento: el tricobezoar es poco frecuente y el síndrome de Rapunzel es muy raro, pero se debe tener presente como diagnóstico diferencial en niñas con trastornos psicológicos y tricofagia, que refieran o no manifestaciones gastrointestinales. Objetivo: presentar el caso de una escolar de nueve años con historia de tricofagia que acude a servicio de Gastroenterología por presentar tumor palpable localizado en epigastrio. Presentación del caso: paciente de nueve años, femenina, que presenta tricotilomanía y tricofagia desde los dos años de vida, que acude por tumor palpable en epigastrio, sin otras manifestaciones clínicas. Conclusiones: el diagnóstico temprano del tricobezoar evita las complicaciones que pueden ser graves y se recomienda un manejo multidisciplinario con el servicio de psiquiatría para controlar la enfermedad de base. La evolución de la paciente fue favorable.
ABSTRACT Background: the tricobezoar is not very frequent and the syndrome of Rapunzel is very strange, but it should be taken into account as differential diagnosis in girls with psychological dysfunctions and trichophagia that refer or not gastrointestinal manifestations. Objective: to present the case of a nine year-old school girl with trichophagia history that goes to service of Gastroenterology to present palpable tumor in epigastrium. Case report: patient of nine years, feminine that presents trichotollomania and trichophagia since she was two years old, she goes for palpable tumor in lengthened epigastrium, without other clinical manifestations. Conclusions: early diagnosis of trichobezoar avoids complications that can be serious, and multidisciplinary management with the psychiatry service is recommended to control the underlying disease. The evolution of the patient was favorable.
RESUMEN
Trichotillomania is a compulsive disorder characterized by repetitive hairpulling. It is an important cause of patchy alopecia, especially in children between 9 and 13 years of age. The aim of this paper is to report 2 pediatric cases presenting with trichotillomania without patches. This condition may be extremely distressful, impacting psychosocial development of children. In these case reports, we reinforce the relevance of trichoscopy in hair disorder evaluation, which allowed early recognition to better advise and conduct these unique pediatric cases.
RESUMEN
BACKGROUND: Relatively few studies have assessed the prevalence, correlates, and independent impact on quality of life (QoL) of trichotillomania (TTM) in large samples. METHODS: Consecutive participants (N = 7639) were recruited from a cross-sectional web-based study. Sociodemographic data were collected and several validated self-reported mental health measures were completed (Minnesota Impulsive Disorders Interview, Hypomania checklist, Fagerström Test for Nicotine Dependence, Alcohol Use Disorders Identification Test, Early Trauma Inventory Self Report-Short Form, and the Symptom Checklist-90-Revised Inventory). Health-related QoL was assessed with the World Health Organization QoL abbreviated scale (WHOQOL-Bref). Multivariable models adjusted associations to potential confounders. RESULTS: The sample was predominantly composed of young females (71.3%; mean age: 27.2 ± 7.9 years). The prevalence of probable TTM was 1.4% (95% confidence intervals [CI]: 1.2-1.7), and was more common among females. Participants with probable TTM had a greater likelihood of having co-occurring probable depression (adjusted odds ratio [ORadj] = 1.744; 95% CI: 1.187-2.560), tobacco (ORadj = 2.250; 95% CI: 1.191-4.250), and alcohol (ORadj = 1.751; 95% CI: 1.169-2.621) use disorders. Probable TTM was also independently associated with suicidal ideation (ORadj = 1.917; 95% CI: 1.224-3.003) and exposure to childhood sexual abuse (ORadj = 1.221; 95% CI: 1.098-1.358). In addition, a positive screen for TTM had more impaired physical and mental QoL. CONCLUSIONS: TTM was associated with a positive screen for several psychiatric comorbidities as well as impaired physical and psychological QoL. Efforts towards the recognition and treatment of TTM across psycho-dermatology services are warranted.
Asunto(s)
Depresión/epidemiología , Calidad de Vida , Trastornos Relacionados con Sustancias/epidemiología , Tricotilomanía/epidemiología , Adolescente , Adulto , Maltrato a los Niños/estadística & datos numéricos , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Encuestas y Cuestionarios/estadística & datos numéricosRESUMEN
Hair-pulling disorder (Trichotillomania) is a disabling mental disorder. Patient's behavior is characterized by the recurrent pulling of own hair with hair loss and a marked dysfunction in various areas of daily life. Trichotillomania is a relatively common disorder with pediatric onset, often associated with significant morbidity, comorbidity, and functional decline. Surprisingly, children or adolescents have been little studied in the research studies on the pathophysiology and psychopathology of trichotillomania. Furthermore, more evidences regarding the effective and evidence-based pharmacological interventions for the treatment of this condition are encouraged. This narrative review will report on the etiopathogenesis and clinical manifestations of trichotillomania including criteria for diagnosis and treatment issues of this complex mental disorder.
Asunto(s)
Enfermedades del Cabello , Tricotilomanía , Adolescente , Niño , Comorbilidad , Humanos , Tricotilomanía/diagnóstico , Tricotilomanía/terapiaRESUMEN
Objective: Trichotillomania (TTM) is characterized by the pulling out of one's hair. TTM was classified as an impulse control disorder in DSM-IV, but is now classified in the obsessive-compulsive related disorders section of DSM-5. Classification for TTM remains an open question, especially considering its impact on treatment of the disorder. In this review, we questioned the relation of TTM to tic disorder and obsessive-compulsive disorder (OCD). Method: We reviewed relevant MEDLINE-indexed articles on clinical, neuropsychological, neurobiological, and therapeutic aspects of trichotillomania, OCD, and tic disorders. Results: Our review found a closer relationship between TTM and tic disorder from neurobiological (especially imaging) and therapeutic standpoints. Conclusion: We sought to challenge the DSM-5 classification of TTM and to compare TTM with both OCD and tic disorder. Some discrepancies between TTM and tic disorders notwithstanding, several arguments are in favor of a closer relationship between these two disorders than between TTM and OCD, especially when considering implications for therapy. This consideration is essential for patients.
Asunto(s)
Humanos , Masculino , Femenino , Tricotilomanía/clasificación , Síndrome de Tourette/clasificación , Trastorno Obsesivo Compulsivo/clasificación , Tricotilomanía/etiología , Tricotilomanía/terapia , Neurobiología , Comorbilidad , Resultado del Tratamiento , Manual Diagnóstico y Estadístico de los Trastornos Mentales , NeuropsicologíaRESUMEN
Los fármacos estimulantes se usan, habitualmente, en la población pediátrica para tratar el trastorno por déficit de atención e hiperactividad, y sus efectos secundarios están bien descritos. Sin embargo, la tricotilomanía no aparece como uno de ellos. En la literatura, hay algunos casos publicados de tricotilomanía en relación con la administración de metilfenidato y dextroanfetamina. Se presentan dos casos de tricotilomanía de nueva aparición en niños en seguimiento en nuestro Centro por déficit de atención e hiperactividad y en tratamiento con fármacos psicoestimulantes (metilfenidato y lisdexanfetamina), como probable efecto adverso de estos.
Stimulant drugs are commonly used in pediatric population in the treatment of attention deficit hyperactivity disorder, and their side effects are well described, however trichotillomania does not appear as one of them. In the literature we found some published cases of trichotillomania in relation to methylphenidate and dextroamphetamine. We present two cases of new-onset trichotillomania in children followed up in our center by attention deficit hyperactivity disorder and treated with psychostimulant drugs (methylphenidate and lisdexamfetamine), as a probable adverse effect of this treatment