Case Report An Unusual Cause of Obstruction of the Appendiceal Lumen : Acute Appendicitis Due to Trichobezoar

Abstract

Acute appendicitis is a common cause of acute abdominal pain in emergency surgical settings, most often resulting from luminal obstruction. The common causes include fecaliths, parasites, lymphoid hyperplasia, and neoplasms. However, obstruction due to hair accumulation—referred to as trichobezoar—is extremely rare, especially in patients without underlying psychiatric disorders such as trichophagia.

We report the case of a 21-year-old Thai female who presented with right lower quadrant abdominal pain, no fever, and no psychiatric history. Her Modified Alvarado Score supported a clinical suspicion of acute appendicitis, although abdominal CT imaging did not reveal specific abnormalities. Surgical exploration via McBurney incision was done. The histopathological revealed an inflamed appendix with a hair mass obstructing the lumen. These findings confirmed acute appendicitis due to trichobezoar. The patient recovered well postoperatively without complications.

This case highlights the importance of considering uncommon causes of appendiceal obstruction, even in patients lacking psychiatric risk factors. It underscores the value of clinical judgment in situations where radiologic findings are inconclusive and reaffirms the role of intraoperative and pathological confirmation in atypical presentations.