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1.
BMJ Case Rep ; 12(12)2019 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-31801773

RESUMO

This is a case of a 14-year-old woman diagnosed with acute pancreatitis based on history and laboratory investigations. CT scan confirmed the diagnosis of acute pancreatitis along with the presence of two bezoars in the stomach and proximal jejunum. Gastroscopy showed a large trichobezoar with difficult endoscopic extraction. Accordingly, the patient underwent laparotomy, gastrostomy and enterotomy with successful removal of the large gastric and jejunal daughter bezoars. Following surgery, pancreatitis resolved and investigations returned to normal. Child psychiatry consultation was sought, and she was diagnosed with trichotillomania and trichophagia.


Assuntos
Bezoares/complicações , Pancreatite/etiologia , Estômago , Tricotilomania/complicações , Dor Abdominal/etiologia , Adolescente , Bezoares/cirurgia , Feminino , Humanos , Tomografia Computadorizada por Raios X
4.
BMJ Case Rep ; 12(6)2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31229972

RESUMO

Trichobezoars are relatively uncommon problems with a known female predominance. We report two female children with gastric bezoars. Main presenting symptoms were abdominal distension, weight loss and anaemia. Upper abdominal mass was palpable in both. Diagnosis was suspected on initial abdominal radiograph and ultrasound scan then confirmed by upper endoscopy. No bowel extension was recorded in either case. We report here a modification of the surgical technique in which the gastrostomy cut edges were anchored to the laparotomy skin. This modification aided easy and complete delivery of hair balls avoiding any spillage or wound contamination.


Assuntos
Dor Abdominal/cirurgia , Bezoares/cirurgia , Gastrostomia , Laparotomia , Radiografia Abdominal , Tricotilomania/patologia , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/etiologia , Bezoares/diagnóstico por imagem , Bezoares/patologia , Criança , Pré-Escolar , Feminino , Gastrostomia/métodos , Humanos , Laparotomia/métodos , Tricotilomania/complicações , Tricotilomania/diagnóstico por imagem , Infecção dos Ferimentos/prevenção & controle
5.
Arch Argent Pediatr ; 117(3): e284-e287, 2019 06 01.
Artigo em Espanhol | MEDLINE | ID: mdl-31063318

RESUMO

Bezoar is an accumulation of organic substances in the gastrointestinal tract; trichobezoar refers to the accumulation of hair usually in the stomach and even beyond it (Rapunzel syndrome). The incidence of this condition is extremely rare, 90 % of cases occur in women, and 80 % of these occur in those under 30 years of age and are related to anxiety behaviors and psychiatric disorders. The integral approach in these patients is fundamental, together with the interdisciplinary follow-up, treating the underlying psycho-emotional causes and adequate psychoeducation with the patients and their relatives, in order to reduce the risk of possible recurrences. We present the clinical case of a patient of school age, with a history of physical abuse by her stepfather and subsequent anxious behaviors (trichotillomania and trichophagia).


Assuntos
Bezoares/diagnóstico , Maus-Tratos Infantis/psicologia , Tricotilomania/complicações , Bezoares/psicologia , Criança , Feminino , Humanos , Tricotilomania/psicologia
7.
Psychiatry Res ; 273: 197-205, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30654305

RESUMO

The study objective was to perform a confirmatory factor analysis of the SLEEP-50 Questionnaire (SLEEP-50) in Trichotillomania (Hair-Pulling Disorder) and Excoriation (Skin-Picking) Disorder and compare sleep complaints in adults with Trichotillomania, Excoriation Disorder and non-affected controls. Participants were 234 adults with Trichotillomania, 170 with Excoriation Disorder, and 146 non-affected controls. Participants rated sleep using the SLEEP-50 and Pittsburgh Sleep Quality Index (PSQI). Confirmatory factor analysis was used to assess fit of the originally-proposed SLEEP-50 factors within Trichotillomania and Excoriation Disorder. Findings revealed acceptable to good fit of the original factors. Internal consistency was excellent in Trichotillomania and good in Excoriation Disorder for the total score and poor to good for subscales. Convergent validity was strong for the total and weak to strong for subscales in both groups. Findings suggest greater sleep complaints in Trichotillomania and Excoriation Disorder than in the general population. Trichotillomania and Excoriation Disorder groups reported greater rates of sleep apnea, narcolepsy, restless leg syndrome/periodic limb movement disorder, circadian rhythms sleep disorder, and sleep-related affective disorder relative to controls. There were no significant differences for insomnia, sleep state misperception, sleepwalking, nightmares, or hypersomnia. Results underscore the importance of clinical assessment of sleep disorders in Trichotillomania and Excoriation Disorder.


Assuntos
Comportamento Autodestrutivo/complicações , Transtornos do Sono-Vigília/psicologia , Sono , Tricotilomania/complicações , Adulto , Estudos de Casos e Controles , Análise Fatorial , Feminino , Humanos , Masculino , Comportamento Autodestrutivo/fisiopatologia , Comportamento Autodestrutivo/psicologia , Pele , Inquéritos e Questionários , Tricotilomania/fisiopatologia , Tricotilomania/psicologia , Adulto Jovem
8.
Sao Paulo Med J ; 137(3): 292-294, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29590232

RESUMO

CONTEXT: Rapunzel syndrome is a rare form of gastric trichobezoar that develops through outstretching of the bezoar from the stomach to the intestine. CASE REPORT: A 12-year-old girl who had been diagnosed with celiac disease six years earlier was brought to the department of pediatric gastroenterology because of abdominal distension. A palpable mass was detected. A trichobezoar that stretched to the small intestine was removed surgically. The patient was diagnosed as having anxiety and depressive disorder, and treatment started. Following the treatment, her previous trichophagia completely disappeared. CONCLUSION: Presence of trichobezoar should be kept in mind, especially when young girls who have psychiatric problems suffer from gastrointestinal symptoms.


Assuntos
Bezoares/diagnóstico por imagem , Doença Celíaca/complicações , Tricotilomania/complicações , Bezoares/cirurgia , Doença Celíaca/psicologia , Criança , Feminino , Humanos , Síndrome , Tomografia Computadorizada por Raios X , Tricotilomania/psicologia
10.
Artigo em Inglês | MEDLINE | ID: mdl-30244268

RESUMO

Trichobezoars are gastric foreign bodies rarely found in children. They are mainly composed of swallowed hair. Rapunzel syndrome is a very rare form of trichobezoar characterized by extension of the ingested hair from the stomach into the small intestine or even beyond. Clinical presentation can range from an asymptomatic abdominal mass to severe symptoms: gastric outlet obstruction, perforation of the stomach, and acute pancreatitis. Trichobezoars are usually treated with surgical removal. Here we present the case of an 8-year-old girl in whom a firm non-tender mass in the epigastric region was palpated during a regular outpatient clinic visit. The girl reported some slight abdominal discomfort and early satiety during meals. Subsequently, focal alopecia was detected. A trichobezoar in the stomach with some extension into the duodenum was diagnosed by ultrasound, and later confirmed by a barium swallow study and CT scan. The trichobezoar was successfully surgically removed.


Assuntos
Bezoares/diagnóstico por imagem , Corpos Estranhos/diagnóstico por imagem , Cabelo , Intestino Delgado/diagnóstico por imagem , Tricotilomania/complicações , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/etiologia , Bezoares/complicações , Bezoares/cirurgia , Criança , Feminino , Corpos Estranhos/etiologia , Humanos , Intestino Delgado/patologia , Intestino Delgado/cirurgia
12.
Riv Psichiatr ; 53(4): 214-217, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30087492

RESUMO

In this paper we present a case of trichotillomania which lasted 33 years, starting with the patient's menarche at 12 years old, and lasting until her first and only pregnancy at 45 years old. We explore the psychodynamic meaning of the hair pulling, both in light of the problems related to introjective and projective processes which, in the kleinian view, gives structure to the internal world and, according to Margaret Mahler, individuation-separation theory. The hypotheses on the significance of this symptom are discovered in part in light of the material which emerged from the patient's intermittent participation in group psychotherapy for nearly five years prior to her pregnancy. Her pregnancy represents the transformational process of this symptom. Her feelings of desperation and anguish, and the rather dramatic expression of them, accompanied by constant suicidal ideas, reveal other conflicts in her primary relationships. The contact with these relational issues is accompanied by a progressive resolution of the trichotillomania. This also comes through in the significantly symbolic shift from the pulling of her own hair to the pulling of the hair from her wig.


Assuntos
Tricotilomania/psicologia , Antidepressivos/uso terapêutico , Criança , Terapia Combinada , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Maior/terapia , Emoções , Feminino , Humanos , Individuação , Relações Pais-Filho , Gravidez , Complicações na Gravidez/psicologia , Técnicas Projetivas , Psicoterapia de Grupo , Psicoterapia Psicodinâmica , Ideação Suicida , Tricotilomania/complicações
14.
BMC Pediatr ; 18(1): 125, 2018 04 04.
Artigo em Inglês | MEDLINE | ID: mdl-29614986

RESUMO

BACKGROUND: Iron deficiency anemia (IDA) and abdominal pain are commonly seen in a pediatric emergency department (8 and 18% incidence respectively in our center). They are manifestations of a wide variety of diseases ranging from benign to immediately life-threatening. Trichobezoar is an under-diagnosed entity that has to be considered in children and adolescents, expecially female, suffering from trichotillomania (compulsion to pull hair) and trichophagy (compulsion to swallow hair). When undiagnosed, gastric bezoars may cause gastric ulceration, perforation, haemorrhage and obstruction. CASE PRESENTATION: To underline the importance of including this pathology in the differential diagnosis of IDA and abdominal pain, we present the case of a 14 year-old girl with a huge trichobezoar which completely filled the stomach and extended into the small bowel. Since trichobezoar has an extension to the small bowel, it is classified as Rapunzel syndrome. As the bezoar couldn't be removed by endoscopy, the girl underwent surgical intervention. The patient passed through a gradual re-feeding, with iron and vitamins supplementation, and through a psychiatric counselling. CONCLUSION: The Rapunzel syndrome is a rare entity that may be complicated by life-threatening events. A prompt diagnosis and an appropriate therapy can reduce comorbidities. Gradual re-feeding with supplementation of micronutrients allows adequate catch-up weight with normalization of haematochemical nutritional parameters. Since many of these patients suffer from psychiatric pathology such as PICA with emotional problems and mental retardation, psychological/psychiatric counselling plays an important role in order to prevent bezoar recurrence.


Assuntos
Dor Abdominal/etiologia , Anemia Ferropriva/etiologia , Bezoares/complicações , Pica/complicações , Tricotilomania/complicações , Adolescente , Bezoares/diagnóstico por imagem , Bezoares/cirurgia , Diagnóstico Diferencial , Duodeno/diagnóstico por imagem , Duodeno/cirurgia , Serviço Hospitalar de Emergência , Feminino , Humanos , Estômago/diagnóstico por imagem , Estômago/cirurgia , Síndrome , Tomografia Computadorizada por Raios X , Ultrassonografia
17.
Aust J Gen Pract ; 47(10): 692-696, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-31195774

RESUMO

BACKGROUND: Hair loss in children aged 12 years and younger is most often due to a benign or self-limiting condition. This article presents a review of the assessment of common causes of paediatric alopecia and outlines the implications for general practice. OBJECTIVE: The objective of this article is to help readers systematically assess a child presenting with alopecia, manage the most common diseases of paediatric alopecia and identify patients requiring referral to a dermatologist. DISCUSSION: The most common causes of paediatric alopecia are largely non-scarring. These include tinea capitis, alopecia areata, trauma due to traction alopecia or trichotillomania, and telogen effluvium. Scarring alopecia can also occur in childhood and requires scalp biopsy and further investigation by a dermatologist. General practitioners should treat clear cases of tinea capitis. Referral to a dermatologist is necessary in cases when the diagnosis is uncertain, treatment is failing or there is evidence of scarring alopecia.


Assuntos
Alopecia/etiologia , Alopecia/fisiopatologia , Alopecia em Áreas/complicações , Alopecia em Áreas/fisiopatologia , Biópsia/métodos , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Anamnese/métodos , Pediatria/métodos , Tinha do Couro Cabeludo/complicações , Tinha do Couro Cabeludo/fisiopatologia , Tricotilomania/complicações , Tricotilomania/fisiopatologia
18.
Pan Afr Med J ; 27: 252, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29187921

RESUMO

Rapunzel syndrome is an extremely rare complication of a gastric trichobezoar in. We report here the unusual case of a case of a 16 years old girl presented with severe abdominal pain and vomiting. Clinical examination revealed a malnourished girl, with presence of a mobile and sensitive abdominal mass of 20x15 cm witch filled the upper quadrant. An abdominal computed tomography scan showed a heterogeneous mass occupying the whole stomach cavity with extension into the third portion of the duodenum. A diagnostic of giant trichobezoar is suspected after further questioning reveling a trichotillomania, trichophagia and onychophagia. The removal of the trichobezoar endoscopically failed and it was possible to pull only few fibers of hair to comfort the diagnostic. She was subjected to an exploratory laparotomy. An antral gastrostomy were performed and a 25x10x7 cm trichobezoar was extracted. The patient had an uneventful postoperative outcome and was derived to psychiatry. Rapunzel syndrome is an uncommon trichobezoar, it's commonly found in young females usually with an underlying psychiatric disorder. Management requires gastrotomy. A psychiatric assessment and a long-term follow-up are advocated as a regular part of treatment to prevent recurrence.


Assuntos
Dor Abdominal/etiologia , Bezoares/diagnóstico , Tricotilomania/complicações , Vômito/etiologia , Adolescente , Bezoares/patologia , Bezoares/cirurgia , Endoscopia/métodos , Feminino , Gastrostomia/métodos , Cabelo , Humanos , Laparotomia/métodos , Desnutrição , Estômago , Tomografia Computadorizada por Raios X
19.
BMJ Case Rep ; 20172017 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-28993354

RESUMO

Trichotillomania can be associated with the formation of trichobezoars (hair ball) usually located in the stomach. Trichobezoars may lead to complications including bowel obstruction, and perforation. Patients with a history of diabetes, certain psychiatric disorders, prior gastric surgery and poor mastication ability are at an increased risk of developing bezoars. We are presenting a case of patient who suffered from a large, recurrent trichobezoar, who had a history of gastric bypass surgery as well as trichotillophagia. The endoscopic method used to remove the large bezoar will also be discussed. We have reviewed the cases published, in which patients developed bezoars after undergoing gastric bypass surgery. The purpose of this study is to raise awareness among clinicians that patients with certain psychiatric issues who had prior gastric surgeries, are at eminent risk of bezoar formation. A multidisciplinary approach including cognitive behavioural therapy, dietary education and pharmacotherapy should be taken to prevent complications.


Assuntos
Bezoares/terapia , Endoscopia/métodos , Derivação Gástrica/efeitos adversos , Remoção de Cabelo/métodos , Complicações Pós-Operatórias , Adulto , Bezoares/etiologia , Bezoares/psicologia , Feminino , Humanos , Recidiva , Tricotilomania/complicações
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