# The Diagnosis of Trichobezoar Based on the Presence of Hypercholesterolemia: A Case Report

## TL;DR

A nine-year-old girl with high cholesterol was found to have a large hairball in her stomach, suggesting a link between trichobezoar and cholesterol levels.

## Contribution

This case report highlights a potential association between trichobezoar and hypercholesterolemia.

## Key findings

- A large trichobezoar was identified in a girl with hypercholesterolemia.
- Cholesterol levels improved after trichobezoar removal.
- The case suggests hypercholesterolemia may be a diagnostic clue for trichobezoar.

## Abstract

Trichobezoar refers to the collection of ingested hair accumulating in the gastric mucosa folds, which are found in patients with trichotillomania and trichophagia. We present a case of a nine-year-old girl in Japan who was found to have hypercholesterolemia in the universal lipid screening as a part of the annual health checkups for the prevention of lifestyle-related diseases. Further examination revealed a palpable mass without any digestive symptoms. Imaging studies and the patient's history of pica indicated trichobezoar and upper gastrointestinal endoscopy revealed a large hairball occupying the entire lumen of the stomach. Thereafter, the large trichobezoar was removed by laparotomy and psychological support was provided to her to prevent its recurrence. Hypercholesterolemia improved after the removal of trichobezoar, which suggests an association between a large trichobezoar and cholesterol metabolism. Hypercholesterolemia may serve as a clue to the identification of trichobezoar.