Journal of Postgraduate Medicine
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Year : 1979  |  Volume : 25  |  Issue : 3  |  Page : 181-182  

Trichobezoar-clinical diagnosis (A case report)

HK Dasgupta, Savita S Chandra, M Gupta, BL Sanwal, SC Bhargawa, RL Vaid 
 Departments of Surgery and Radiology, S. P. Medical College, Bikaner, Rajasthan., India

Correspondence Address:
H K Dasgupta
Departments of Surgery and Radiology, S. P. Medical College, Bikaner, Rajasthan.


Abdominal crepitus over the gastric trichobezoar in the diag­nosis of the same is elucidated and documented radiologically

How to cite this article:
Dasgupta H K, Chandra SS, Gupta M, Sanwal B L, Bhargawa S C, Vaid R L. Trichobezoar-clinical diagnosis (A case report).J Postgrad Med 1979;25:181-182

How to cite this URL:
Dasgupta H K, Chandra SS, Gupta M, Sanwal B L, Bhargawa S C, Vaid R L. Trichobezoar-clinical diagnosis (A case report). J Postgrad Med [serial online] 1979 [cited 2020 Oct 23 ];25:181-182
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Since 1779 when Baudamant [1] first described the entity of trichobezoar in Eglish literature, the scattered case re­ports bespeak for its rarity. But for Joshi and Shirole, [2] the literature is silent on the "crepitus" as a diagnostic sign in gastric trichobezoar.

The purpose of this case report is to further substantiate the observation of Joshi and Shirole [2] with radiological do­cumentation of crepitus in the clinical diagnosis of trichobezoar.

 Case report

Ichari, a female child of 7 years was admitted with history of trichophagy since the age of 2 years and gradually increasing abdominal mass and discomfort of 3 years' duration. The mass was extending from underneath the left hypo­chondrium to right hypochondrium with central abdominal bulge. The peristaltic wave was seen to traverse the same area from the left to right. The mass was mildly tender and firm and was immobile in transverse direction but did move with respiration. A fine crepitus could be felt over the area of mass. She was anaemic, the scalp hair was normal. Hb was 7 gm%.

Radiological Investigation

Plain X-rays of the abdomen (A.P. and late­ral views) were taken following ingestion of Seidlitz powder to accentuate the gas in stomach for the purpose of documentation (see [Figure 1], on page 182A).

Barium meal picture of the stomach demon­strated the characteristic mottled distribution of barium by trichobezoar

Subsequent to one unit of blood transfusion she was operated upon and trichobezoar (see [Figure 2] on page 182A) was removed through gas­trotomy. The trichobezoar was forming almost a complete cast of stomach with extension into the first part of duodenum.


The commonest clinical presentation of trichobezoar has been that of an apathe­tic, anaemic, anorexic, psychopathic child (Adults are no exception) with an intra­abdominal mass of trichobezoar which may either form a complete cast of stomach or remain free inside the stomach giving rise to abdominal discom­fort, nausea, vomiting or occasionally haemetemesis. Rarely daughter hair balls lead on to acute intestinal obstruc­tion.

Clinical diagnosis should be thought of, if either history of trichophagy is narrat­ed or else the crepitus is felt over the ab­dominal mass.

We wish to point out that "crepitus" may not always be elicited unless the trichobezoar formed almost the complete cast of the stomach, which may be the reason for lack of recognition of Joshi and Shirole's observation [2] so far.


1Baudamant (1779) : "History de la Societ.c Royala de medicine" Paris. Vol. II. Quoted by Trafford, H. S., Trichobezoar, Lancet. 1: 761, 1954.
2Joshi, V. S. and Shirole, B.: Inio-tri­chobezoar: Ind. J. Paediat., 27: 294-296, 1960.

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