An unusual case report of rapunzel syndrome trichobezoar in a 3-year-old boy

Jain, Manish; Solanki, Sohan Lal; Bhatnagar, Ankur; Jain, Pavan Kumar

doi:10.4103/0974-7753.90820

Cited by 18 publications

(11 citation statements)

References 12 publications

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“…Trichobezoars are diagnosed almost exclusively in adolescent females, although cases of several-years-old children were also reported [ 4 , 5 ]. Trichobezoars are very rarely detected in young male patients [ 6 – 8 ].…”

Section: Discussionmentioning

confidence: 99%

Trichobezoar, Rapunzel Syndrome, Tricho-Plaster Bezoar – A Report of Three Cases

Czerwińska

Bekiesińska‐Figatowska²,

Brzewski

et al. 2015

Pol J Radiol

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SummaryBackgroundTrichobezoar is an uncommon entity observed mostly in young women. Symptoms in presenting patients are usually due to the large mass of the bezoar or malabsorption of nutrients. Trichobezoar is almost always associated with trichotillomania and trichophagia.Case ReportThree teenage girls, aged 13, 15, and 16, were diagnosed due to palpable epigastric masses. Additionally the oldest patient presented with symptoms of ileus while the other two patients had weight loss and anaemia. Besides the 15-year-old patient complained of paroxysmal abdominal pains. Patients were subjected to plain radiographic examinations of abdomen which revealed large epigastric tumours, with additional calcifications observed in the youngest girl. Subsequent gastroscopy (the 15-year-old patient) or ultrasonographic examination and computed tomography scans (13- and 16-year-old patients) allowed to establish the diagnosis of giant bezoars: trichobezoars in two older patients and tricho-plaster bezoar in the youngest one. All the tumours were surgically resected and psychiatric treatment was undertaken.Conclusions1. Trichobezoar should be taken into consideration in differential diagnosis of epigastric tumours in children, especially teenage girls. 2. The conventional ultrasonographic and radiographic examinations of the abdomen are insufficient for determination of the nature of the mass. A thorough medical history interview and clinical examination may give directions regarding the further diagnosis.3. Trichotillomania and trichophagia are obsessive-compulsive disorders, and therefore patients with trichobezoars should be under psychiatric care to prevent recurrence of the disease.

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Section: Discussionmentioning

confidence: 99%

Trichobezoar, Rapunzel Syndrome, Tricho-Plaster Bezoar – A Report of Three Cases

Czerwińska

Bekiesińska‐Figatowska²,

Brzewski

et al. 2015

Pol J Radiol

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“…Nour y cols, en otra revisión (2017), encontraron cuatro casos del síndrome de Rapunzel en pacientes masculinos (16). En este estudio se encontró que la presencia de tricobezoar fue mayor en el sexo femenino, reportándose solo cinco casos en el masculino (17)(18)(19)(20)(21). El rango de edad encontrado en esta población fue de un año hasta 55 años; pero, de acuerdo con Dindyal y cols., en el extremo superior se ubica a la población masculina (18) y en el extremo inferior, la femenina (22).…”

Section: Discussionunclassified

“…La tricotilomanía es una entidad rara y poco diagnosticada, que, si no se trata a tiempo, las complicaciones que esta genera pueden llevar a la muerte. De los 110 casos reportados como síndrome de Rapunzel, solamente cuatro tuvieron desenlace fatal (19,22,31,32). De estos, el 75 % (n=3) fue en el sexo femenino, con un rango de edad entre uno y cinco años.…”

Section: Discussionunclassified

Revisión sistemática del Síndrome de Rapunzel

et al. 2020

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RESUMEN. Introducción: El síndrome de Rapunzel es una forma inusual de tricobezoar gástrico, se localiza desde el estómago llegando a traspasar el píloro y extendiéndose hasta el intestino delgado y/o colon derecho. Se le llama bezoar a la formación de cuerpos extraños, debido a la ingestión de uno o varios materiales no digeribles. El tricobezoar, uno de los bezoares que más se presentan en la práctica clínica consisten en una masa formada por cabello debido a la ingestión de este.Objetivo: describir la frecuencia de signos y síntomas del síndrome de Rapunzel en los reportes de caso y ofrecer una comparación en edad pediátrica y adulta.Método. Revisión sistemática en la base de datos PubMed, Google Académico, EBSCO y Scopus, empleando los términos “Rapunzel syndrome” AND “case report” OR “Clinical case”Resultados. Un total de 110 artículos de reporte de caso fueron analizados, encontrando diferencias por sexo y edad. La tricotilomanía se distribuyó sin predominancia por grupo de edad. Se identificaron diferencias en el reporte de algunas manifestaciones clínicas al analizarlas por grupo de edad, incluyendo diarrea, constipación, vómitos y dolor abdominal. Los casos recidivantes representaron un 9%.Conclusiones: El síndrome de Rapunzel es una entidad que se encuentra en pacientes con patologías psiquiátricas como la tricotilomanía y la tricofagia. Es más frecuente en mujeres que en hombres. La técnica diagnóstica por elección fue la endoscopía y el tratamiento elegido incluyó la remoción quirúrgica con psicoterapia. Palabras clave: síndrome de Rapunzel, signos y síntomas, bezoar, diagnóstico, tricotilomanía, adolescencia. Introduction: Rapunzel syndrome is an unusual type of gastric trichobezoar, which is located from the stomach through the pylorus and extends into the small intestine and/or right colon. Tricobezoar is a collection of foreign bodies that can form in the stomach, small intestine or colon, due to the ingestion of one or more indigestible materials. trichobezoar, one of the most present bezoars in Clinical practice consists of a mass formed by hair due to the ingestion of it, either consciously or unconsciously. Objective: To compile case reports to identify and analyze little-known aspects of Rapunzel syndrome, as well as patient characteristics along with the best and most documented methods of diagnosis and treatment. Method. Systematic review in the Pubmed, Google Scholar, EBSCO and Scopus databases using as search terms: "Rapunzel syndrome" AND "case report" OR "Clinical case" Results: A total of 110 case report articles were analyzed, finding differences by sex and age. Trichotillomania was distributed without predominance by age group. Differences were identified in the reporting of some clinical manifestations when analyzed by age group, including diarrhea, constipation, vomiting and abdominal pain. Recidivist cases were 9%. Conclusion: Throughout the review of reported cases, we found that part of the patient's recovery includes psychiatric treatment; Rapunzel syndrome is not a mental disorder, however, both trichotillomania and pica as factors of it. The entity is more frequent in women than in men, the technique for diagnosis by choice was the endoscopy and the chosen treatment included surgical removal with psychotherapy. Keywords: Rapunzel Syndrome, Signs and Symptoms, Bezoar, Diagnosis Trichotillomania, Adolescence.

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“…Open surgery and extraction is the usual mode of removing the tricobezoar as it is technically easy, have low rates of complications, 100% success rate and enables complete assessment of small bowel for other areas of bezoar [3,5]. Laparoscopic approach has long duration of surgery due to complexity of procedure, risk of contamination and less success rates [5].…”

Section: Discussionmentioning

confidence: 99%

“…In some cases the mass extends beyond the stomach in to duodenum known as the Rapunzel Syndrome [3,4]. Upper GI endoscopy is the diagnostic investigation [1].…”

Section: Discussionmentioning

confidence: 99%