An Unlikely Culprit—Trichobezoar

This article documents the presence of a trichobezoar (“hair ball”) adhered to the luminal surface of staples within the jejunum of an 11-year-old spayed female Labrador retriever. The trichobezoar created a mass effect and partial obstruction, causing the dog to experience 3 months of poor appetite, weight loss, and progressive clinical signs of intestinal obstruction that included intermittent vomiting and passage of reduced quantities of feces for 2 to 3 weeks. The staples were from a circular end-to-end anastomosis stapling device (CEEA), used 2 years previously for an enterectomy secondary to extensive necrosis of the small intestine (cause not reported). Histopathologic examination of the resected trichobezoar mass showed changes consistent with severe ulcerative neutrophilic enteritis and normal lymph nodes. The dog recovered uneventfully from surgery to relieve the obstruction and was fine 6 months after the procedure. This appears to be the first documented case of a trichobezoar formation around CEEA staples causing obstruction in a dog.

A CEEA device is used in humans and animals for end-to-side and end-to-end gastrointestinal anastomoses. Advantages include less tissue manipulation, trauma, bleeding, and edema, as well as faster return of gastrointestinal function and patient recovery. Complications in dogs and cats have been reported as bleeding and rectovaginal fistula formation. Use of CEEA stapling devices has been limited by patient size and by perceived risk for anastomotic stricture.

Trichobezoars are typically found in the stomachs of cats and are usually removed by vomiting. Small intestinal obstruction by a trichobezoar has been documented in only 5 cats and 2 dogs (1 of which also had an intestinal mass located distal to the mass of undigested hair). Although rare, hair accumulation at the site of E (CEEA) staples should be listed as a potential long-term complication of the technique.

COMMENTARY: This unusual cause of small intestinal obstruction reminds us that even obscure benign masses should not be forgotten in exploration of a geriatric, obstructed animal.—Heather Troyer, DVM, Diplomate ABVP (Canine & Feline Practice)

Trichobezoar obstruction after stapled jejunal anastomosis in a dog. Carobbi B, Foale RD, White RAS. VET SURG 38:417-420, 2009.