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Background: Trichobezoar is a condition characterized by the accumulation of undigested hair and or other foreign bodies in the stomach. The reported occurrence is uncommon in the Middle East and usually affects female adolescents and young children. Rapunzel syndrome, which almost exclusively affects young women, is a rare form of trichobezoar in the stomach that spreads to the intestine and is associated with psychiatric disorders such as trichotillomania and trichophagia.

Case Presentation: This report describes a rare case of giant trichobezoar complicated with acute pancreatitis in a young patient which was ultimately treated with the removal of trichobezoar by surgical gastrotomy.

Conclusion: Trichobezoar is an underdiagnosed and rare disease that should be addressed in adolescents with trichotillomania and trichophagia with delicate clinical symptoms, especially in females. Endoscopy can help with a definitive diagnosis and surgery remains the gold standard for the treatment of this condition

Published in, New Emirates Medical Journal – July 2023

 Traumatic brain injury (TBI) occurs commonly in children. Repeat  computed tomography (CT) follow up of TBI patients is often scheduled to  identify progressive hemorrhagic injury (PHI). However, the utility of  repeated CT scans, especially in children with mild TBI [Glasgow Coma  Scale (GCS) scores of 13–15], has been debated. The purposes of the  present study were to identify clinical predictors of PHI in children  with mild TBI and to clarify relevant clinical factors via radiological examination.  https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2017.00560/full

 From 2014 to 2016, we retrospectively enrolled children <15 years of  age with mild TBI. We recorded age, sex, GCS scores on admission, causes  of head injury, timing of initial CT, any loss of consciousness,  vomiting and seizure data, and type of TBI. Based on repeat CT findings,  patients were dichotomized into either a PHI group or a non-PHI group.  Also, clinical data were comparatively reviewed. Multivariate logistic  regression analysis was used to identify clinical predictors of PHI. 

 Of the 175 enrolled children, 15 (8.6%) experienced PHI. Univariate  analysis revealed that GCS score on admission, cause of head injury,  vomiting, seizure, and TBI type were associated with PHI. Multivariate  logistic regression analysis showed that a GCS score of 13 and epidural  hemorrhage (EDH) were independently associated with PHI (hazard ratio =  0.131, P = 0.018; hazard ratio = 6.612, P = 0.027, respectively). 

 A GCS score of 13 and EDH were associated with PHI. These factors should  be considered when deciding whether to repeat CT on children with mild  TBI. 

 Traumatic brain injury (TBI) is common in children and is an important cause of disability and morbidity (1).  The incidence of TBI in children is estimated to be 250 per 100,000 per  year. TBI accounts for >7,000 deaths and 600,000 emergency  department visits annually among children in the United States (2). The vast majority of TBIs in children are mild, requiring no specific therapy, and associated with no sequelae (1).  However, a small proportion of patients presenting with mild TBI  develop progressive hemorrhagic injury (PHI). Therefore, it is important  to recognize and intervene early in PHI to improve prognosis. Computed  tomography (CT) scanning for initial evaluation of TBI is  well-established. Repeat CT is also frequently performed. However,  neither the indications for, nor the timing of, repeat CT scans in  children are well-established. Most centers routinely schedule CT for  patients with moderate or severe TBI, but the utility of such an  approach remains debatable in patients with mild TBI, especially  children. Studies advocating routine repeat CT suggest early medical  intervention via osmotic therapy or surgical intervention  featuring placement of an intracranial pressure monitor or craniotomy  before neurological deterioration is evident (3–5).  However, several recent studies have questioned this practice, rather  advocating the use of repeat CT only for non-examinable patients and  those exhibiting no improvement on neurological examination (6, 7).  Children are more vulnerable to the carcinogenic effects of radiation  than are adults because of their higher cell replication rates and their  longer expected lifespans. It is well-known that the younger the age at  the time of radiation exposure, the higher the risk of cancer induction  (8, 9).  Minimizing the number of CT scans is of great importance in children,  because of the increased risk of lethal malignancies induced by exposure  to ionizing radiation (10, 11).  No present guideline addresses the utility of repeat CT in terms of the  follow up of mild TBI in children. The purposes of this study were to  assess the predictive role of clinical factors on admission in children  with mild TBI using sequential radiological examination. 

 We found that a GCS score of 13 and EDH significantly  increased the risk of PHI in children <15 years of age with mild TBI.  These factors should be considered as indications for repeat CT  examination.