Upper abdominal mass in children.

We present 2 pediatric cases with abdominal mass. The first case was a 12-year-old girl who presented with upper abdominal pain for 1 week with intermittent episodes of vomiting non-bloody, non-bilious in nature but no diarrhea and no fever. Abdominal examination showed a firm mass in the left upper quadrant. X-ray of the abdomen showed distended gastric viscus with inspissated content with transition zone at the pylorus raising the suspicion of bezoar (Figure 1). The patient was taken to the operating room and the big mass of hair was removed with open laparoscopy (Figure 2). The second case was a 7-year-old with a history of recurrent upper abdominal pain for a few months with no vomiting, fever, or diarrhea. She had a history of eating foreign objects (hair and pencil erasers). Abdominal examination suggested a firm mass in the epigastric area. X-ray of the abdomen was inconclusive. Computed tomography (CT) of the abdomen and pelvis with contrast was obtained, which showed bezoar in the gastric cavity (Figure 3). The patient was taken for open laparoscopy and a mass of hair was extracted (Figure 4). In both cases, psychiatric evaluation and follow-up was arranged. Trichobezoar is a mass of ingested hair (mostly patient's own hair) that accumulates in the gastrointestinal tract, mostly in the gastric mucosa. In some cases, gastric bezoars extend into the small intestine and are called Rapunzel syndrome.1 Trichobezoars are rare in children. Gastrointestinal trichobezoar usually present with signs and symptoms, such as abdominal pain, vomiting, and abdominal mass; whereas, in some cases, they manifest as small bowel obstruction, gastric perforation, intussusception, and bleeding per rectum.2 Trichobezoars are diagnosed with imaging (CT scan) and endoscopy. The management of trichobezoar requires a two-pronged approach. The initial step requires laparotomy/laparoscopic removal of the trichobezoar followed by psychiatric evaluation and follow-up to prevent trichophagia and recurrence.3