The latest issue of The New England Journal of Medicine features an unusual case of trichobezoar (tricho- for “hair”; bezoar for “indigestible mass in stomach or intestine”), otherwise known as a stomach hairball. The patient is an 18 year-old lady who presented to the Rush University Medical Center (Chicago, IL) with a 5-month history of abdominal pain and vomiting with meals. Computed tomography (CT) demonstrates a large mass in the stomach (see Figure A), which likely contributed to the reported symptoms. Esophagogastroduodenoscopy (EGD)–the insertion of a camera via the oral cavity and advanced to the upper segments of the digestive tract–was able to visualize the impressive bezoar (see Figure B), measuring 37.5 x 17.5 x 17.5 cm. It was later discovered the patient had a habit of eating her own hair (trichophagia). The only option for removal was open surgery. The extracted bezoar weighed 4.5 kg and can be seen in Figure C. Not surprisingly, the patient stopped eating her hair, experienced an improvement in symptoms, and eventually regained her weight.
Mr. Jones is a 65 year-old gentleman with a past medical history significant for hypertension (HTN), diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), and coronary artery disease (CAD), who presents from OSH with … who-knows-what?
OSH denotes an “outside hospital” from where a patient was transferred. These hospitals are generally smaller medical centers that do not have the advanced specialists, equipment, or support facilities to manage the evolving complexity of a patient’s disease. Consequently, they request from a higher-level care center (i.e., tertiary hospital, major academic institution) to have the patient transferred there. In rare instances where patients carry cryptic or immensely challenging clinical diagnoses, a tertiary center may even refer the patient to another hospital where supposed “world experts” of a particular field may practice.
A common complaint at tertiary centers receiving transferred patients is that they arrive with poor supporting documentation. That is, what had been done for the patient while at the other hospital? What happened whereby the patient now requires higher level care? Discharge summaries sometimes appear as if they were drafted on the fly; at other times, they are replaced by randomly copied chart notes or nothing altogether. In worse scenarios, patients may arrive with such dearth of information that the admitting physician is left dumbfounded about the real reasons for admission.
In response, a group of medicine residents from the University of Pennsylvania created the following video to critique–with gross exaggeration, of course–the infamous OSH.
Disclaimer: the video is intended to be a comedic satire and does not reflect the standard of care at OSH. Training programs, practicing medical professionals, and health care organizations are closely monitored by an army of acronyms, such as the ACGME (Accreditation Council for Graduate Medical Education), ABIM (American Board of Internal Medicine), JCAHO (Joint Commission on Accreditation of Healthcare Organizations), etc.
