Complicated Rapunzel syndrome mimicking intussusception

Rapunzel syndrome presenting as jejuno-jejunal intussusception

“…In one such case of suspected intussusception preoperatively, on exploration, the entire trichobezoar was found to have migrated en bloc from the stomach to the terminal ileum, leading to ileal perforation. The tail of the trichobezoar was extending through the ileocecal valve up to the hepatic flexure, and the bezoar was extracted through the site of perforation [14]. Unlike our case of true intussusception, this was a case of a distal ileal mass due to a sealed perforation, which mimicked intussusception preoperatively.…”

“…In a review of 27 cases reported in 2007, only two noted the presence of intussusception [2]. These occurrences are usually reported in pediatric age groups, and thus may require multiple enterotomies for complete extraction of a long tail of hair [12][13][14]. In one such case of suspected intussusception preoperatively, on exploration, the entire trichobezoar was found to have migrated en bloc from the stomach to the terminal ileum, leading to ileal perforation.…”

Trichobezoar as a cause of pediatric acute small bowel obstruction

“…Given the rarity of TTM and trichophagia, it is estimated that only 1‐2 people per million will be affected by trichobezoar. To our knowledge, there are only six documented cases of children younger than our patient having a trichobezoar and in only one of these was the site of impaction in the small intestine . Rapunzel syndrome has been described as an uncommon form of this condition, but even more rare is the complete passage of a gastric trichobezoar through the pylorus into the small bowel causing a subsequent acute small bowel obstruction, as was found in our case.…”

“…To our knowledge, there are only six documented cases of children younger than our patient having a trichobezoar 5,17,18,[21][22][23] and in only one of these was the site of impaction in the small intestine. 23 Rapunzel syndrome has been described as an uncommon form of this condition, but even more rare is the complete passage of a gastric trichobezoar through the pylorus into the small bowel causing a subsequent acute small bowel obstruction, as was found in our case. Our patient therefore represents a highly unusual variant of trichobezoar, given her age and the location of the pathology.…”

Small bowel obstruction caused by dried apple

“…A bezoar is a mass of undigested material which accumulates in the gastrointestinal tract, most often in the stomach. Bezoars can be classified according to the type of undigested material and include food bolus bezoar, phytobezoar (non digestible particles from fruits and vegetables), lactobezoar (solidified milk), diospyrobezoar (unripe persimmons), pharmacobezoar (pills and medications) and trichobezoar (hairballs) [2,6,8] . Although bezoars are well documented, the diagnosis and treatment remains a challenge [6] .…”