Supplementary Material for: Beyond IBD: calprotectin as a marker for trichobezoar? A case report

Trichobezoar is an aggregation of swallowed hair strands that entangle in the stomach. It presents with abdominal pain, vomiting, and diarrhea. Diagnosis is usually made by imaging and endoscopy. Surgical removal is typically required, but endoscopic retrieval has been successful. Fecal Calprotectin is a biomarker of inflammation that is typically elevated in inflammatory bowel disease (IBD) but is also elevated in other gastrointestinal (GI) disorders such as infections. Trichobezoar is not known to precipitate GI inflammation and has never been reported among the etiologies of elevated fecal calprotectin. Herein, is a case presenting with vague abdominal pain, and elevated fecal calprotectin that was attributed solely to a trichobezoar. A 7-year-old girl presented with abdominal pain for 6 months associated with occasional vomiting and diarrhea. Family history was positive for ulcerative colitis. Physical examination was unremarkable including normal growth. Diagnostic workup revealed elevated fecal calprotectin at 433.9 mg/kg. Upper and lower endoscopies were performed. A trichobezoar with Rapunzel syndrome was incidentally found in the stomach extending into the duodenum without frank obstruction. Histology showed reactive gastropathy in a few areas of mechanical rubbing by hair strands, otherwise was completely unremarkable in both upper and lower GI biopsies. Endoscopic retrieval of piecemeal hair locks was done. Surgical removal was subsequently done due to the generous size of the mass. In conclusion, fecal calprotectin is an important biomarker for IBD, as well as other unusual GI pathologies, and clinical context is crucial when interpreting its value.

毛粪石（Trichobezoar）是指吞咽的毛发丝缠绕积聚于胃内形成的团块。其临床表现为腹痛、呕吐及腹泻。诊断通常借助影像学检查与内镜检查确立。临床通常需行手术切除治疗，但内镜下取出术亦已获得成功。粪便钙卫蛋白（Fecal Calprotectin）是一种炎症生物标志物，在炎症性肠病（IBD）中通常呈升高状态，在感染等其他胃肠道（GI）疾病中亦可出现升高。目前尚无证据表明毛粪石可诱发胃肠道炎症，且其从未被纳入粪便钙卫蛋白升高的病因谱中。本文报告1例以不明原因腹痛为表现、粪便钙卫蛋白升高的病例，其指标异常仅由毛粪石所致。一名7岁女童因6个月持续性腹痛就诊，伴偶发呕吐及腹泻。患儿存在溃疡性结肠炎家族史。体格检查未见异常，生长发育指标均处于正常范围。相关检验检查显示其粪便钙卫蛋白水平达433.9 mg/kg，显著升高。完善上、下消化道内镜检查后，意外于胃内发现伴长发公主综合征（Rapunzel syndrome）的毛粪石，该团块已延伸至十二指肠，但未造成明确梗阻。组织病理学检查显示，在毛发丝机械摩擦的少数区域可见反应性胃病，其余上、下消化道活检标本均未见明显异常。术者采用分块方式内镜下取出毛发团块，因肿块体积较大，后续追加了手术切除。综上，粪便钙卫蛋白是炎症性肠病及其他罕见胃肠道病变的重要生物标志物，临床背景信息在解读其检测结果时至关重要。