Case series of pediatric gastric trichobezoars: diagnostic challenges, management outcomes, and the imperative for psychiatric follow-up.

Introduction and importance: Trichobezoar (TBZ) is a rare gastric mass composed of ingested hair, strongly linked to psychiatric conditions like trichotillomania (TTM) and trichophagia (TPH) that predominantly affect young females. Diagnosis, based on clinical suspicion, is best confirmed by CT or gastroscopy, though point-of-care ultrasound (POCUS) is a valuable initial tool. Management is ranging from endoscopic retrieval for small bezoars to surgical resection for large or complex cases. We present this series to highlight the diagnostic challenges, underscore the essential psychiatric dimension, and emphasize a recurrence risk of some cases. Case presentation: This report details five pediatric TBZ cases that all required surgical intervention for large masses (>10 cm). Presenting symptoms varied, encompassing anemia, abdominal discomfort, and failure to thrive. Diagnosis was achieved via POCUS, gastroscopy, CT, or MRI with subsequent surgical extraction performed via laparotomy or laparoscopy. Despite successful surgical outcomes, inconsistent psychiatric follow-up led to one case of recurrence following the resumption of hair-eating behavior. Clinical discussion: These cases underscore TBZ as a dual surgical and psychiatric condition. Successful management hinges on early imaging and a multidisciplinary approach. Clinicians should maintain a high index of suspicion for TBZ in children presenting with unexplained anemia and abdominal pain. Furthermore, psychiatric referral is imperative, even when hair-eating behaviors have ostensibly ceased, to address the underlying pathology and mitigate the significant risk of recurrence. Conclusion: The effective management of TB necessitates close collaboration between pediatric surgeons and psychiatrists from the point of diagnosis to ensure behavioral interventions are integrated with surgical care.