Hairball

A 16 year old girl with trichotillomania since the age of 3, presented acutely with coffee-ground vomiting and abdominal pain. A large, firm, non-tender epigastric mass was palpable and an abdominal ultrasound, and barium meal showing a large filling defect, suggested the diagnosis. This was confirmed by laparotomy, when a 1·3 kg trichobezoar (hairball) that had entirely filled the stomach was removed. Bezoars are hard, indigestible masses of organic material that rarely cause bowel obstruction, with the bezoar tail extending into the small intestine. Other types include phytobezoars (non-digestible food material), and pharmacobezoars (tablets or semi-liquid drugs).