Bezoar in the Practice of General Practitioner and Pediatrician: Clinical Case – Rapunzel Syndrome

Abstract

Introduction. Bezoar is a cluster of foreign, inedible or difficult to digest objects in the digestive tract (especially in the stomach). Depending on the composition, there are: phytobezoars, trichobezoars, pharmacobezoars, lactobezoars. Patients may not have any symptoms for years, and their appearance is associated with an bezoar size enlargment, then there is abdominal pain, bloating, nausea and vomiting, a feeling of rapid satiety, anorexia and weight loss. The small bowel obstruction is the often cause of acute surgical pathology in the case of bezoar. It is important to pay attention to the peculiarities of the patient’s behavior, halitosis, spotted alopecia. The purpose of this publication was to raise the awareness of pediatricians and general practitioners in the diagnosis and management of patients with bezoars. The article presents a review of the literature and the clinical case of trichobezoar (Rapunzel syndrome) in a 14-year-old girl. Conclusions. Bezoar, regardless of its nature, disrupts the function of the gastrointestinal tract and can cause acute surgical complications patients of all ages. General practitionersn and pediatricians, taking into account the risk factors and clinical symptoms, may suspect bezoar formation in the early stages. In pediatric practice at the stage of primary diagnostic search, ultrasound can be recommended as a less invasive, but quite informative method. The “golden standard” for verification and treatment of uncomplicated forms of bezoar is the endoscopic method, regardless of age. Phytobezoars are less common in our region, but the processes of globalization, migration and increase in the diet of exotic fruits and vegetables may actualize this pathology. Adolescents, mostly girls who have long-term dyspeptic symptoms, alopecia, weight loss, especially if it occurs against the background of difficult social circumstances or pre-existing psychiatric disorders, are at risk of developing trichobezoar, so they need careful examination and consultation with a psychiatrist.