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Tricobezoar gástrico : a expressão física de um problema maior
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O tricobezoar, uma consolidação de cabelos ingeridos, é uma patologia rara, que se verifica principalmente em crianças e mulheres jovens com patologia psiquiátrica subjacente. A sua apresentação é frequentemente inespecífica, com sinais e sintomas como dor abdominal, anemia e perda ponderal, podendo levar a um diagnóstico tardio e a possíveis complicações graves, como oclusão intestinal e perfuração de víscera oca.
Apresenta-se assim o caso clínico de uma criança de 9 anos, que recorreu ao serviço de urgência do Hospital Beatriz Ângelo por dor abdominal, vómitos e ausência de dejeções com 3 dias de evolução. À observação destacava-se uma massa epigástrica dura, associada a anemia ferropénica e sinais de desnutrição. Assumiu-se inicialmente a hipótese de obstipação crónica, mas por fraca resposta à terapêutica de desimpactação intestinal e agravamento clínico, foi alargada a investigação. Realizou-se uma TC abdomino-pélvica, que revelou extensa distensão e invaginação intestinal, associada a estase alimentar, tendo-se confirmado a presença de um tricobezoar gástrico por EDA, que foi extraído por gastrotomia. Após anamnese mais cuidada e investigação da situação social e familiar, acabou por se documentar uma história de ansiedade, dificuldades de socialização e de tricotilomania e tricofagia com 2 anos de evolução, associada a um contexto familiar profundamente disfuncional, tendo a criança sido institucionalizada.
A terapêutica do tricobezoar passa pela sua extração e resolução do quadro orgânico e pela prevenção da sua recorrência, com intervenção da psicologia e psiquiatria, sendo essencial a realização de terapia cognitivo-comportamental e apoio social e familiar para a eliminação dos comportamentos patológicos. O tricobezoar acaba assim por ser uma expressão física grave de um problema maior: uma patologia psiquiátrica que, sem o tratamento adequado, pode prejudicar gravemente o desenvolvimento e a vida futura.
The trichobezoar, a collection of ingested and consolidated hair, is a rare pathology, mainly found in children and young women with an underlying psychiatric disorder. Its presentation is frequently non-specific, with signs and symptoms like abdominal pain, anaemia and failure to thrive, which can lead to a late diagnosis and severe complications, such as intestinal obstruction and bowel perforation. A case of a 9-year-old child is presented, who came to the emergency department of Hospital Beatriz Ângelo, with complaints of abdominal pain, vomiting and constipation for 3 days. On examination there was a palpable hard epigastric mass, in association with iron-deficiency anaemia and signs of malnutrition. Chronic constipation was initially assumed, but due to poor response to the desimpaction regime and worsening symptoms, it was necessary to widen the investigation. An abdominal and pelvic CT scan was performed, revealing extensive intestinal distension and intussusception, associated with gastric stasis, with the presence of a gastric trichobezoar confirmed by upper GI endoscopy, which was then removed by gastrotomy. Following a more thorough medical history and investigation of the child’s family and social background, a history of anxiety, socialization difficulties, trichotillomania and trichophagia in the last two years was documented, in association with a profoundly dysfunctional family life, which led to the child being institutionalized.A case of a 9-year-old child is presented, who came to the emergency department of Hospital Beatriz Ângelo, with complaints of abdominal pain, vomiting and constipation for 3 days. On examination there was a palpable hard epigastric mass, in association with iron-deficiency anaemia and signs of malnutrition. Chronic constipation was initially assumed, but due to poor response to the desimpaction regime and worsening symptoms, it was necessary to widen the investigation. An abdominal and pelvic CT scan was performed, revealing extensive intestinal distension and intussusception, associated with gastric stasis, with the presence of a gastric trichobezoar confirmed by upper GI endoscopy, which was then removed by gastrotomy. Following a more thorough medical history and investigation of the child’s family and social background, a history of anxiety, socialization difficulties, trichotillomania and trichophagia in the last two years was documented, in association with a profoundly dysfunctional family life, which led to the child being institutionalized.The therapeutic approach of a trichobezoar relies on its extraction and resolution of the acute organic disorder, and preventing a relapse, with intervention of a team of psychologist and psychiatrist. Attendance to cognitive-behavioural therapy and social support are essential to promote the elimination of pathological patterns. A trichobezoar turns out to be the physical expression of a deeper problem: a psychiatric disorder that, without proper treatment, can severely hinder a child’s future development and adult life.
The trichobezoar, a collection of ingested and consolidated hair, is a rare pathology, mainly found in children and young women with an underlying psychiatric disorder. Its presentation is frequently non-specific, with signs and symptoms like abdominal pain, anaemia and failure to thrive, which can lead to a late diagnosis and severe complications, such as intestinal obstruction and bowel perforation. A case of a 9-year-old child is presented, who came to the emergency department of Hospital Beatriz Ângelo, with complaints of abdominal pain, vomiting and constipation for 3 days. On examination there was a palpable hard epigastric mass, in association with iron-deficiency anaemia and signs of malnutrition. Chronic constipation was initially assumed, but due to poor response to the desimpaction regime and worsening symptoms, it was necessary to widen the investigation. An abdominal and pelvic CT scan was performed, revealing extensive intestinal distension and intussusception, associated with gastric stasis, with the presence of a gastric trichobezoar confirmed by upper GI endoscopy, which was then removed by gastrotomy. Following a more thorough medical history and investigation of the child’s family and social background, a history of anxiety, socialization difficulties, trichotillomania and trichophagia in the last two years was documented, in association with a profoundly dysfunctional family life, which led to the child being institutionalized.A case of a 9-year-old child is presented, who came to the emergency department of Hospital Beatriz Ângelo, with complaints of abdominal pain, vomiting and constipation for 3 days. On examination there was a palpable hard epigastric mass, in association with iron-deficiency anaemia and signs of malnutrition. Chronic constipation was initially assumed, but due to poor response to the desimpaction regime and worsening symptoms, it was necessary to widen the investigation. An abdominal and pelvic CT scan was performed, revealing extensive intestinal distension and intussusception, associated with gastric stasis, with the presence of a gastric trichobezoar confirmed by upper GI endoscopy, which was then removed by gastrotomy. Following a more thorough medical history and investigation of the child’s family and social background, a history of anxiety, socialization difficulties, trichotillomania and trichophagia in the last two years was documented, in association with a profoundly dysfunctional family life, which led to the child being institutionalized.The therapeutic approach of a trichobezoar relies on its extraction and resolution of the acute organic disorder, and preventing a relapse, with intervention of a team of psychologist and psychiatrist. Attendance to cognitive-behavioural therapy and social support are essential to promote the elimination of pathological patterns. A trichobezoar turns out to be the physical expression of a deeper problem: a psychiatric disorder that, without proper treatment, can severely hinder a child’s future development and adult life.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
Palavras-chave
Tricobezoar Tricotilomania Tricofagia Obstipação Pediatria