A 13-year-old girl with neurofibromatosis presented to the ER with emesis and anorexia for 3 days. A firm epigastric mass was palpated on physical examination. The rare diagnosis of gastric neurofibroma was suspected. Supine abdominal radiograph demonstrated mottled lucencies distending the stomach and simulating a large, recently ingested meal (Fig. 1). CT revealed a mixed air and soft-tissue density intraluminal gastric mass, confirming the diagnosis of a gastric bezoar (Fig. 2). Subsequently, our patient admitted to habitually ingesting foam and hair. Patient’s IQ was normal.
Up to 90% of trichobezoars occur in girls younger than 20 years. Common associations are mental retardation, pica, and trichotillomania . Gastric bezoars often present with acute symptoms and sometimes respond to conservative or endoscopic therapy . In our patient, the bezoar was removed via open surgery forming a cast of the stomach (Supplementary materials available with this article online).
Video demonstrating the surgical removal of the bezoar in the operating room. (AVI 7970kb)
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