Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2023; 15(5): 972-977
Published online May 27, 2023. doi: 10.4240/wjgs.v15.i5.972
Mallory-Weiss syndrome from giant gastric trichobezoar: A case report
Eva Lieto, Annamaria Auricchio, Maria Paola Belfiore, Giovanni Del Sorbo, Gabriele De Sena, Vincenzo Napolitano, Alessio Ruggiero, Gennaro Galizia, Francesca Cardella
Eva Lieto, Annamaria Auricchio, Giovanni Del Sorbo, Gabriele De Sena, Vincenzo Napolitano, Alessio Ruggiero, Gennaro Galizia, Francesca Cardella, Department of Translational Medical Sciences, University of Campania L. Vanvitelli, Napoli 80138, Campania, Italy
Maria Paola Belfiore, Department of Precision Medicine, University of Campania L. Vanvitelli, Napoli 80138, Campania, Italy
Author contributions: Lieto E and Auricchio A conceptualized and designed the study, and contributed equally; Cardella F drafted and reviewed the manuscript for important intellectual content; Del Sorbo G and Ruggiero A reviewed the literature and drafted the manuscript; Belfiore MP contributed radiologic findings; Napolitano V and De Sena G contributed endoscopic findings; Galizia G and Lieto E critically reviewed the final manuscript and provided final approval of its content; and all authors issued final approval for the version to be submitted.
Informed consent statement: Consent was obtained from the patient’s guardians for anonymized publication of this case report and accompanying images.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Eva Lieto, MD, PhD, Associate Professor, Department of Translational Medical Sciences, University of Campania L. Vanvitelli, Piazza Miraglia, 2, Napoli 80138, Campania, Italy.
Received: December 3, 2022
Peer-review started: December 3, 2022
First decision: December 26, 2022
Revised: January 2, 2023
Accepted: April 7, 2023
Article in press: April 7, 2023
Published online: May 27, 2023

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.


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.


According to our knowledge, this is the first-ever described case of MWS due to an excessively large trichobezoar.

Keywords: Mallory-Weiss syndrome, Upper gastrointestinal bleeding, Trichobezoar, Ringworm, Psychiatric distress, Case report

Core Tip: We presented the case of an adolescent female with Mallory-Weiss syndrome due to a giant intragastric trichobezoar formed after several years of a misunderstood condition of hair-eating, worsened by the forced isolation during the coronavirus disease 2019 pandemic. Accurate anamnesis, the strong involvement of family that has always denied any responsibility, and upper gastrointestinal endoscopy were used to reach the diagnosis. Since the excessive dimension of the trichobezoar inhibited endoscopic treatment, the entire foreign body was removed via surgery. After an uneventful postoperative period, the patient was referred to a Psychiatric Unit for further treatment.