Introduction: A 4 year old female presented with a one month history of intermittent vomiting and abdominal pain acutely worsening over two weeks. The patient had a two year history of trichotillomania and trichophagia and was repeatedly observed eating her own hair and hair from hairbrushes. On physical exam, the patient was pale and underweight. An abdominal mass was palpable in the epigastric and left upper quadrant. Lab work was significant for anemia. CT scan demonstrated a gastric mass extending into the duodenum. Endoscopy revealed a large gastric trichobezoar obstructing the gastric lumen, as well as gastric ulceration. Endoscopic removal was not feasible and the patient was taken for laparoscopic removal.

Methods: Access to the abdomen was achieved via a 5mm umbilical incision. 5mm trocars were then placed in the umbilicus, right upper quadrant and left mid-abdomen. A 12mm trocar was placed in the left lower quadrant. Using the ultrasonic scalpel, a 5cm anterior gastrotomy was made. The trichobezoar was removed en bloc and placed in an endobag which was pulled through the 12mm incision. Due to its size, the trichobezoar was broken up using clamps and extracted piecemeal. The gastrotomy was then repaired in two layers. The peritoneal cavity was inspected for debris and irrigated. The trichobezoar weighed 192gm, and measured 15x15x7cm.

Results: The postoperative course was unremarkable. The patient was discharged home post-operative day four tolerating regular diet and with referral to child psychiatry.

Conclusion: At five month follow-up the patient gained weight, had no signs of alopecia and no longer suffered from trichophagia.