Trust Your Gut


She came into the ER with a chief complaint of abdominal pain.  It had been going on for a few months with little improvement.  She had seen her doctor a few times for it, but the results remained inconclusive.  She had been losing weight, unable to eat more than a few bites, and gradually weakening.  Not good for a young teen.

On initial inspection, she appeared well, but her vitals signs were off.  She seemed to be just a complete straight shooter, honest, earnest, anxious, and frustrated with months of discomfort.  She had too much pain in her upper abdomen.  My gut told me to check out her gut.

I did the normal array of labs, all of which were negative.  Then I ordered a CT scan of the abdomen, which also came back essentially negative.  The only oddity was her overly full stomach.

I talked to the radiologist about it, who stated she must have recently consumed a large meal.  I had already spoken with the patient about this, and she told me she had not had anything to eat in over 24 hours.  In fact, she told me that recently whenever she ate anything she got full really quickly.

So what the heck was going on?  Was she lying?  How could she have such a full stomach?

Then, like a puked up hairball to the face while sleeping, it hit me… a bezoar!

Some people, often young women, have nervous tendencies to chew on their hair.

This habit causes few problems other than split ends and hair in the teeth (I for one love a woman with hairy teeth).  If this habit gets out of hand, the accumulation of hair and debris can cause what is called a bezoar.

Unfortunately for my patients, she did have the habit of chewing on her hair when she was nervous.  This seemed to be all the time recently since she had been having abdominal pain that no one could figure out for the last six months.  On the CT scan, the bezoar present in her stomach looked just like a normal stomach filled with food, but that “food” was actually a large mass of undigested Fortunately for her, a bezoar can be surgically removed and with behavior modification, she should do splendidly.

bezoar1

 

Mmmmm, that’s some tasty hair!

 

Also, don’t forget that a bezoar is what Harry Potter used to save Ron’s life after he was poisoned.  People used to believe that bezoars had magical healing properties.  Not sure how eating undigested particulate matter magically heals you, but hey, who am I to question JK Rowling!

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