Trichobezoar is a rare intriguing disorder in which swallowed hairs accumulates in the stomach. Being indigestible and slippery, it could not be propulsed and becomes entrapped within the stomach. Large amounts can thus accumulate over the years forming a hair ball. Rapunzel syndrome is a variant where hair accumulation reaches the small gut and beyond in some cases. Although the syndrome has been known for many years, only 24 cases have been reported in the literature and the discovery of a new case is always surprising. In this report, we present two cases discovered within a period of three months. One of them was pregnant and had small bowel intussusception and perforation, a very rare combination. We hereby add two more cases to the literature. To our knowledge, this is the first report on two cases of Rapunzel syndrome, the diagnosis of which demands a high index of suspicion.

The spleen is a rare location for hydatid cysts with the larvae reaching the site after escaping the hepatic and pulmonary filters. For most surgeons, splenectomy is the primary treatment in such cases which aims at eradicating the disease while decreasing the chances of recurrence by removing the intact cyst. While this is true, the risks of other two parasitic infections are increased, namely malaria and babesiosis. In the case presented here, the spleen was preserved after extirpating the cyst to keep the patient's immunity against malaria, which is endemic in our region. KeywordsSplenectomy, hydatid cyst, immune function * Corresponding author: ezzedien@hotmail.com Canines are the definitive hosts of the tapeworm Echinococcus granulosus. Humans are accidental intermediate hosts by consuming food or water contaminated by the eggs of the parasite. In the small intestine the eggs hatch and the released larvae penetrate the intestinal wall to gain access to the circulation and reside in different organs, primarily the liver, forming cysts. The disease is endemic in sheep and cattle rearing countries in both the developed and developing world (Bauman 2004).A 30-year-old female presented with pain in the left hypochondrium. On examination, she looked generally well; the vital signs were within normal and chest and heart examination showed no abnormality. The abdomen was soft with a palpable mobile mass in the left upper quadrant and bowel sounds were normal. Apart from a slightly raised white cell count (10.7 cell/cubic mm) there was no biochemical or haematological abnormalities.An ultrasound (US) and computerized axial tomography (CT) scan of the abdomen showed a large cystic lesion, 10 × 15 cm, occupying the upper half of the spleen with the characteristic appearance of hydatid cyst (Figs 1 and 2). The liver and kidneys were normal and no other lesions were detected. The diagnosis was splenic hydatid cyst and the patient was prepared for surgery.On call to surgery, intravenous Augmentin (amoxicillin and clavulanic acid) was given. Hydrocortisone was also given at the start of the operation and the abdomen was entered through a left subcostal incision. There were dense adhesions between the enlarged spleen and the anterior abdominal wall. At the medial aspect of the spleen, there was a fluctuant area marking the cyst. After isolation of the area with abdominal packs, aspiration and re-injection of the cyst cavity with 0.5% silver nitrate solution was done twice. The cyst was then opened and evacuated of the laminated membrane and all debris or membrane remnants were thoroughly removed (Fig. 3). A drain was inserted in the cyst cavity and the abdomen was closed.Oral feeding was started in the first postoperative day and the diet was gradually built up. The drain was removed on the fifth day when the drainage fluid became nil, and the patient was discharged on the 7th post-operative day.During her outpatient follow up three months later, she remained in good health and the cavity previously occupied by ...