Holy Flaming Hairballs, Batman

I really enjoy the papers that show up on Veronique Greenwood and Valerie Ross’ Discoblog, and occasionally share them here.  Here’s a paper that warns of flaming hairballs during surgery.

First a couple of definitions.–

Iatrogenic: adjective (of a medical disorder) caused by the diagnosis, manner, or treatment of a physician.

Trichobezoar: A wad of swallowed hair. Also called a hairball. Trichobezoars can sometimes be found to cause blockage of the digestive system, especially at the exit of the stomach. They are seen almost exclusively in female children, 6-10 years old, with bizarre appetite and emotional disturbances

And in a bit of trivia, in ancient times, the solid mass occasionally found in the stomach of a goat or an antelope was thought to have magical healing powers and even rejuvenating properties

Electrocauterization (or electrocautery) is a safe procedure that is routinely used in surgery to remove unwanted or harmful tissue. It can also be used to burn and seal blood vessels, which helps reduce or stop bleeding.

A small probe with an electric current running through it is used to burn or destroy the tissue. A grounding pad is placed on the body (usually the thigh) before the surgery to protect the patient from the harmful effects of the electricity.

Here the abstract of the paper:
Beware of the flaming hairball–a brief review and warning.
Raval MV, Weiner TM. J Pediatr Surg. 2005 Apr;40(4):E37-8.

 Operating room fires are receiving increasing attention in the medical literature and in the general public. The best way to reduce these iatrogenic, sometimes devastating, events is communication and education. The authors present the case of a 14-year-old adolescent girl who had an apparent explosive event during a laparotomy for removal of a large gastric trichobezoar. This event was presumably associated with gas production under increased pressures in the gastrointestinal tract caused by an obstructive and decomposing trichobezoar. This is the first reported association between trichobezoars and potential intraoperative fire and/or injury. It is the recommendation of the authors to avoid the use of electrocautery when initially entering a portion of the gastrointestinal tract thought to contain a bezoar to avoid the potential for surgical fire or concussive tissue damage.

Some more background and trivia from Wikipedia; the place we turn when the accuracy of the information is unimportant.

Beozoars are any mass that forms a blockage in the gastrointestinal tract, and can have several sources.

  • Food boluses (or boli, singular, bolus) imitate true bezoars and are composed of loose aggregates of food items such as seeds, fruit pith, or pits, as well as other types of items such as shellac, bubble gum, soil, and concretions of some medications.
  • Lactobezoar is a specific type of food bezoar comprising inspissated milk. It is most commonly seen in premature infants receiving formula foods.
  • Pharmacobezoars (or medication bezoars) are mostly tablets or semiliquid masses of drugs, normally found following overdose of sustained-release medications.[9]
  • Phytobezoars are composed of indigestible plant material (e.g., cellulose), and are frequently reported in patients with impaired digestion and decreased gastric motility.
  • Diospyrobezoar is type of phytobezoar formed from unripe persimmons.[10] Coca-Cola has been used in the treatment.[11][12]
  • Trichobezoar is a bezoar formed from hair[13] – an extreme form of hairball. Humans who frequently consume hair sometimes require these to be removed. The Rapunzel syndrome, a very rare and extreme case, may require surgery.

Beozoars were thought to be antidotes for any type of poison, in fact, the word “beozoar” comes from the Persian word for antidote.

The Andalusian Muslim physician Ibn Zuhr (d. 1161), known in the West as Avenzoar, is thought to have made the earliest description to bezoar stones as medicinal items.[6]

In 1575, the surgeon Ambroise Paré described an experiment to test the properties of the bezoar stone. At the time, the bezoar stone was deemed to be able to cure the effects of any poison, but Paré believed this was impossible. It happened that a cook at King’s court was caught stealing fine silver cutlery and was sentenced to death by hanging. The cook agreed to be poisoned instead. Ambroise Paré then used the bezoar stone to no great avail, as the cook died in agony seven hours later.[7] Paré had proved that the bezoar stone could not cure all poisons as was commonly believed at the time.

A court case in 1603 involving a non-functiong Beozoar added the rule of caveat emptor, “let the buyer beware” to the English Common Law.

The case concerned a purchaser who sued for the return of the purchase price of an allegedly fraudulent bezoar. (How the plaintiff discovered the bezoar did not work is not discussed in the report.)

As I said, Holy Flaming Hairballs, Batman.

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