Trichobezoar is a unique rare condition predominantly of childhood and adolescence. It is a black, glistening, foul smelling mass, made up of hairs present in the alimentary tract, commonly in stomach. There is usually a preceding history trichotillomania (pulling own hairs) followed by trichophagia (ingestion of hairs).
Not all the cases of trichotillomania have trichophagia nor all the trichophagia develop trichobezoar. Although the exact cause of trichotillomania is not clear certain psychosocial, behavioral, and biological theories have been proposed like childhood trauma, stress and neurochemical imbalances (like of serotonin) [3
Hairs are non absorbable or digestible and also due to smooth slippery texture not easily pass out of the alimentary tract. They remain stuck in the folds of alimentary tract and usually jumbled up in stomach. This bunch of hair can have extension in to distal bowel as a result of peristaltic propulsion. It may get detached as satellite in distal intestine with main part in the stomach. There are recurrent episodes of non specific pain in abdomen, loss of appetite, vomiting and weight loss. Alopecia is the most significant associated symptom in patients with this condition [5
The patient in this report had onset of trichotillomania at a very early age (2 years) which has been reported, though rarely. Contrary to the usual cases, where these children have behavioral disturbances and failure to thrive, our patient showed normal physical and mental health. She started pulling and eating her hairs at the age of two years and left after 18months without any specific reason or change of environment, which shows that it is not always the underlying behavioral or psychological disturbance that leads to this habit. This could be “short term habit of hair pulling” which is quite different from trichotillomania. Jealously with the other siblings is a normal phenomenon (as the psychiatrist pointed out in our case) [9
Isolated intestinal trichobezoars are rare but do occur and can have delayed presentation, even after many years of leaving trichophagia. In the index case the trichobezoar might remained in the stomach for years and then dislodged from stomach and stuck in the small bowel, therefore, presented with the acute intestinal obstruction. It is also an interesting fact that in the stomach the trichobezoars do not produce any kind of symptoms for years.
To conclude, delayed presentation of trichobezoar is a rare event. Ileal trichobezoar should be placed in differential of mobile abdominal masses in young girls.