Трихобезоари як прояв порушень психічного здоров’я дітей: погляд хірурга та психіатра

Abstract

Трихобезоари в дітей являють собою рідкісні сторонні тіла шлунка та тонкої кишки, які мають властивості з часом непомітно збільшуватися в розмірах, клінічно проявляючись диспепсичними розладами, пухлиноподібним утворенням в епігастральній ділянці, симптомами високої шлунково-дуоденальної або тонкокишкової непрохідності. Діти із зафіксованими епізодами трихотиломанії та трихофагії потребують консультації психіатра та психотерапевта, а також фіброгастродуоденоскопії для заперечення трихобезоарів. Діти, оперовані з приводу трихобезоарів, потребують післяопераційної психіатричної допомоги та психологічної підтримки для попередження рецидиву. Aim - to summarise the experience of treating children with trichobezoars, to consider aspects of the relationship between surgery and psychiatry, and to determine the tactics of postoperative psychiatric/psychological care. Materials and methods. In the period from 2002 to 2023,6 girls aged 9 to 13 years with trichobezoars were treated. In 3 cases the children had gastric trichobezoars, in 2 cases Rapunzel syndrome was diagnosed, and in 1 case a small intestinal trichobezoar was found. In one child, a small gastric trichobezoar was removed endoscopically, in 5 children, large trichobezoars were removed during laparotomy. Results. The presented clinical cases illustrate this rare pathology in terms of the relationship between pediatric surgery and psychiatry. Effective correction of mental disorder, which is a predictor of trichobezoar formation in children, allows stabilising the patient's emotional condition and prevents the disease recurrence. A comprehensive multidisciplinary approach to the management of patients with trichobezoars after surgery should include patient consultation by a mental health professional, psychoeducational consultation of parents and relatives regarding trichotillomania and trichophagia as pathological conditons that precede the formaton of trichobezoars. Neuropsychiatric examination and treatment, long-term follow-up, and behavioural therapy are recommended as a regular part of comprehensive treatment and relapse prevention. Conclusions. Trichobesoars in children are rare foreign bodies of the stomach and small intestine that have the ability to increase imperceptibly in size over time, clinically manifesting as dyspeptic disorders, tumour-like masses in the epigastric region, and symptoms of high gastroduodenal or small intestinal obstruction. Children with documented episodes of trichotillomania and trichophagia require consultation with a psychiatrist and psychotherapist, as well as fibrogastroduodenoscopy to exclude trichobesoar. Children who have been operated on for trichobezoar require postoperative psychiatric care and psychological support to prevent relapse. The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from parents (or guardians) and children.