Late Recurrence of Giant Gastric Trichobezoar Manifested as Severe Upper Gastrointestinal Bleeding: Case Report and Brief Literature Review

Introduction: Gastric trichobezoars are an uncommon clinical entity characterized by the progressive accumulation of ingested hair within the gastric cavity, commonly associated with trichotillomania and trichophagia. Clinical presentation is variable, ranging from chronic dyspeptic symptoms to potentially severe complications such as gastrointestinal obstruction, perforation, or gastrointestinal bleeding. Late recurrence after initial surgical treatment represents an exceptionally rare phenomenon. Case presentation: A 43-year-old female patient with a previous surgical history of gastric trichobezoar at 20 years of age, as well as trichotillomania and trichophagia without active psychiatric follow-up, presented to the emergency department with asthenia, adynamia, fatigue, palpitations, and melena, associated with coffee-ground vomiting. Physical examination revealed a non-mobile indurated epigastric mass with decreased peristalsis. Laboratory studies documented severe anemia (hemoglobin 5.9 g/dL) and elevated nitrogenous waste products. Computed tomography demonstrated a large heterogeneous intragastric mass with near-complete occupation of the gastric chamber and antropyloric extension, consistent with a recurrent giant trichobezoar. Following hematologic stabilization with transfusion of four units of packed red blood cells and multidisciplinary inpatient management, an exploratory laparotomy with anterior gastrotomy and fragmented extraction of a 1,980 g gastric trichobezoar was performed. Postoperative evolution was satisfactory, with progressive reintroduction of oral intake and hospital discharge without complications. Conclusions: Recurrent gastric trichobezoar may present decades after initial treatment and manifest atypically as severe upper gastrointestinal bleeding. Open surgery remains a safe and effective therapeutic strategy in cases of giant or complicated bezoars. Long-term psychiatric follow-up is essential to reduce the risk of recurrence.