背景:Mallory-Weiss综合征(MWS),代表胃食管连接处的线性粘膜撕裂,是上消化道出血的常见原因,通常由习惯性呕吐引起。在这种情况下,随后的心脏溃疡可能是由于胃内压力升高和胃食管括约肌闭合不当所致,共同诱导缺血性粘膜损伤。通常,MWS与所有呕吐状况有关,但它也被描述为长时间内窥镜手术或摄入异物的并发症。
方法:我们在此描述了一例患有MWS和慢性精神痛苦的16岁女孩上消化道出血的病例,后者在她父母离婚后恶化了。病人,在2019年冠状病毒病大流行封锁期间居住在一个小岛上,有2个月的习惯性呕吐病史,呕血,还有轻微的抑郁情绪.最终,发现一个巨大的胃内梗阻性毛黄,并发现是由于一个隐藏的习惯,不断吃自己的头发;这个习惯一直持续了过去5年,直到食物摄入量急剧减少和相应的体重减轻。在没有上学的情况下,她的生活状态相对孤立,这加剧了她的强制习惯。毛发聚集已经达到如此巨大的尺寸,并且其坚固性是如此硬,以至于其用于内窥镜治疗的潜力被认为是不可能的。患者接受了手术干预,最终完全清除了肿块。
结论:根据我们的知识,这是有史以来第一例由过大的毛孔引起的MWS病例。
BACKGROUND: Mallory-Weiss syndrome (MWS), representing a linear mucosal laceration at the gastroesophageal junction, is a quite frequent cause of upper gastrointestinal bleeding, usually induced by habitual vomiting. The subsequent cardiac ulceration in this condition is likely due to the concomitance of increased intragastric pressure and inappropriate closure of the gastroesophageal sphincter, collectively inducing ischemic mucosal damage. Usually, MWS is associated with all vomiting conditions, but it has also been described as a complication of prolonged endoscopic procedures or ingested foreign bodies.
METHODS: We described herein a
case of upper gastrointestinal bleeding in a 16-year-old girl with MWS and chronic psychiatric distress, the latter of which deteriorated following her parents\' divorce. The patient, who was residing on a small island during the coronavirus disease 2019 pandemic lockdown period, presented with a 2-mo history of habitual vomiting, hematemesis, and a slight depressive mood. Ultimately, a huge intragastric obstructive trichobezoar was detected and discovered to be due to a hidden habit of continuously eating her own hair; this habit had persisted for the past 5 years until a drastic reduction in food intake and corresponding weight loss occurred. The relative isolation in her living status without school attendance had worsened her compulsory habit. The hair agglomeration had reached such enormous dimensions and its firmness was so hard that its potential for endoscopic treatment was judged to be impossible. The patient underwent surgical intervention instead, which culminated in complete removal of the mass.
CONCLUSIONS: According to our knowledge, this is the first-ever described
case of MWS due to an excessively large trichobezoar.