[Adult intestinal no rotation]

90% of cases of intestinal obstruction caused by intestinal malrotation occur in children under 1 year of age, being very uncommon in adults. A female patient of 27 years of age consults with abdominal pain, vomiting, abdominal distention, dehydration and signs of severe malnutrition. After EGDS, CT scan, and 48 hours of clinical expectation, surgical intervention was decided with diagnosis of high intestinal obstruction. Intraoperative finding was no intestinal rotation at all. Ladd´s technique was performed together with prophylactic appendectomy. Postoperative evolution was favorable. The rare presentation in adults motivates the presentation of this case.

[Primary anal tuberculous fissure]

The anal tuberculous (TBC) fissure is infrequent. For this reason diagnosis is difficult. A case of a female adult patient with anal TBC fissure that consults for bleeding and perianal pain is presented. The perianal tuberculosis is a rare manifestation of the general disease. A routine biopsy must be performed, with the corresponding histopathologic study. A specific origin should be suspected when an anal chronic fissure, painful and bleeding, without response to the habitual treatment, is found. The primary TBC fissure can be cured with the administration of three drugs during 3 to 4 months.

[Gastro-duodenal trichobezoars: a rare cause of obstruction of the gastrointestinal tract]

BACKGROUND

Trichobezoars represent 55% of human bezoars. Patients are women in 90% of cases and have some psychiatric disorder in 40%.

OBJECTIVE

To study the clinical features, diagnostic methodology and treatment in patients with trichobezoars.

DESIGN

Retrospective analysis of clinical records and case report.

METHOD

Four patients were included between January 2000 and March 2004, 3 women and 1 man, with a mean age of 32.3 years (range 22 to 73 years).

RESULTS

All patients had an epigastric mass, dyspepsia, vomiting, and weight loss of 5 to 25 kg, without pain. Three patients underwent barium studies, and all of them ultrasonography, computerized tomography and upper gastrointestinal endoscopy. All of them received endoscopic procedures without treatment success. Any patient referred trichophagy and all of them had psychiatric disorders. The surgical treatment was gastrotomy and removal of the bezoar. The average weight was 1,100 g (range 700 to 1,500 g).

CONCLUSIONS

The trichobezoar is a rare cause of obstruction of the gastrointestinal tract. The diagnosis should be suspected with the clinical and barium study findings, and confirmed by computerized tomography and endoscopy. Surgery is the treatment of choice. However, other treatments have been described, such as endoscopic fragmentation, extracorporeal lithotripsy and laparoscopic extraction.