Giant gastric trichobezoar associated with intestinal pneumatosis in a patient with tuberculosis: a case report from Bolivia

Abstract

Introduction: Giant gastric trichobezoar is a rare entity in pediatrics, generally associated with trichophagia; its insidious course hinders timely diagnosis and predisposes patients to serious complications. Case report: A 13-year-old adolescent presented with chronic abdominal pain and a palpable mass. Laparotomy revealed a giant gastric trichobezoar and extensive intestinal pneumatosis; concomitant peritoneal tuberculosis was identified via Xpert MTB/RIF® testing. The patient had a favorable postoperative outcome. Discussion: The exceptional coexistence of these three entities highlights that the pneumatosis resulted from a mechanical-ischemic obstructive mechanism, whereas the tuberculosis was an independent finding. This underscores the value of molecular tools when facing atypical intraoperative presentations. Conclusions: This case reaffirms the need for broad, multidisciplinary diagnostic reasoning when dealing with complex abdominal findings, avoiding unsubstantiated causal interpretations. A multidisciplinary approach is essential for identifying concomitant pathologies, optimizing treatment, and improving prognosis in cases of atypical abdominal presentation.