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From question on page 1261

The scan demonstrates an intragastric mass with a whorled configuration containing multiple small pockets of air. Free air is also seen in the peritoneal cavity, suggesting gastric perforation, most probably as a result of pressure necrosis from trichobezoar causing ulceration and subsequent perforation.

The patient had a subsequent gastrotomy where a huge trichobezoar was removed from the stomach. It later transpired that the patient had eaten her hair as an adolescent and that she had recently been discharged from a local dermatology clinic following treatment for alopecia.

Attempting to establish a clinical diagnosis of trichobezoar is extremely challenging as symptoms may mimic other pathologies. Eliciting a history of trichophagia, the presence of alopecia, and a high index of suspicion may all aid the clinician, but more often than not, the diagnosis, as in this case, is made only after radiological investigation.

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