Trichobezoar: A rare cause of hyperemesis in a pregnant woman. 

This case report reinforces awareness of the diagnostic challenge posed by trichobezoars in young pregnant women as a differential diagnosis of hyperemesis gravidarum. 

An 18-year-old young girl was admitted with severe vomiting at 14 weeks of gestation. She was admitted on two previous occasions with a similar history.  She wasdischarged on oral antiemetics and supplements, but was unable to tolerate these medications. In the absence of any other systemic signs, the abdominal pain was thought to be due to gastritis and proton pump inhibitors and liquid antacids.  Symptoms persisted. 

She was commenced on hydrocortisone as per guidance, with which her vomiting subsided and nausea improved. She continued to complain of severe upper abdominal pain which did not subside despite antacids and morphine. As she had not opened her bowel for 4 weeks, an enema was administered but with no effect. 

Bowel sounds were noted to be sluggish. Her serum lactate was normal. She underwent an emergency MRI that revealed an intestinal obstruction. 

She underwent an emergency laparoscopy that was converted to laparotomy. Small bowel obstruction was identified due to a 6x4 cm ball of hair (Figure 2) that was removed after a jejunostomy. Post-op recovery was uneventful. Retrospectively, she, revealed that she had been in the habit of sucking on her hair over the past two years, especially while watching television.