However, a calcified mass, neuroblastoma, aneurysm, abscess, or fecal material can appear similarly on an ultrasound (4). Ultrasound has been shown to be effective in diagnosing bezoars in up to 88% of cases if a “clean” acoustic shadow, which represents a solid mass, can be visualized (4, 5).
Trichobezoars are nearly impossible to diagnose by plain film alone. This mass is a trichobezoar (3), first described in 1779 by Baudomant (4). As more hair is added, the resulting mass causes the stomach to cease peristalsis completely. Thus, when hair is ingested, it gets trapped in the mucosa of the stomach. The smooth surface of hair does not allow for its propagation through peristalsis. With this background information, further evaluation was deferred until after the surgery, when the identity of the mass would be elucidated. Meanwhile, Emily had started at a new school and was doing well academically and socially. Kim, however, expressed private concern that Emily was not dealing with the loss of her father. After this, the parents’ relationship became strained, and Emily had not seen her father in a year.Įmily was briefly in counseling to help her deal with the changes in her life surrounding her parents’ separation, but the counselor felt that she was coping well and did not require further psychotherapy. Emily’s father, however, had a substance abuse problem that led to dissolution of the marriage 2 years before admission.
Kim felt that family life had been generally good during the marriage and that her husband had been a good father Emily was especially close to him. Up until 2 years before, Emily had lived with her mother, siblings, and father in their own home. She had many friends and was enrolled in a mainstream public school second-grade class that she enjoyed.Įmily lived in the home of a family friend with her mother (Kim), her older half sister, and her younger brother. By her own and her mother’s account, she was happy and well adjusted. and A.M.) met with Emily and her mother the morning before surgery. Her mother reported no change in her bowel habits and stated that Emily never wanted to eat much in one sitting. Upon further questioning, Emily reported no stomach pain, nausea, vomiting, reflux, diarrhea, flatulence, recent illnesses, or fever. Emily’s pediatrician did not think the mass was consistent with a neoplasm but was concerned that it could be a conglomeration of something she had ingested. The abdominal CT demonstrated a free-floating mass that filled the entire stomach and was surrounded by a thin rim of contrast material ( Figure 1). On reevaluation the next day, Emily’s pediatrician still palpated the same mass, leading him to order a computed tomography (CT) scan of the abdomen. However, her mother reported that Emily had not eaten since breakfast, 4 hours earlier. The study showed no evidence of any abnormalities, although the technician did note that Emily must have just eaten because her stomach was full. Upon physical examination, her pediatrician noted a nontender palpable mass in the child’s stomach, leading him to order an abdominal ultrasound. Although Emily had voiced no complaints, her mother had noted that she had appeared paler than usual. Emily (all names and identifiers have been changed to protect confidentiality) was a 7-year-old girl seen by her pediatrician for a routine annual examination.
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