Trichobezoar Causing Small Bowel Obstruction, Perforation, and Meckel's Diverticulum: Rare Case

Abstract

 Trichobezoars, rare gastrointestinal masses composed of ingested hair, predominantly affect young females with underlying psychiatric conditions such as trichotillomania and trichophagia. Rapunzel syndrome, a severe form of trichobezoar, extends into the small intestine and can lead to complications such as obstruction and perforation. Meckel's diverticulum, an embryological remnant of the vitellointestinal duct, may also serve as a nidus for bezoar impaction, exacerbating the risk of intestinal obstruction. We present a rare case of a 16-year-old male with no prior psychiatric history who developed acute small bowel obstruction and multiple jejunal perforations due to trichobezoars, one of which was lodged within a Meckel's diverticulum. Clinical presentation included abdominal pain, distension, vomiting, and constipation. Imaging suggested small bowel obstruction with intraluminal hyperdense contents. Exploratory laparotomy revealed two trichobezoars, three jejunal perforations, and an inflamed Meckel's diverticulum. Surgical management included resection of the involved ileal segment with primary anastomosis, jejunal repairs, and loop jejunostomy. Postoperative recovery was uneventful. This case highlights the unusual occurrence of trichobezoar in a male adolescent with associated Meckel's diverticulum and jejunal perforation a combination scarcely documented in the literature. Early suspicion, timely imaging, and prompt surgical intervention are essential in preventing morbidity. The presence of Meckel's diverticulum should raise the index of suspicion for bezoar-related complications in unexplained small bowel obstruction,

especially in younger patients.