Beware of the flaming hairball—a brief review and warning

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.