Giant gastric trichobezoar in a young female with Rapunzel syndrome: case report

Abstract

Rapunzel syndrome is an extremely rare complication of a gastric trichobezoar in. We report here the unusual case of a case of a 16 years old girl presented with severe abdominal pain and vomiting. Clinical examination revealed a malnourished girl, with presence of a mobile and sensitive abdominal mass of 20x15 cm witch filled the upper quadrant. An abdominal computed tomography scan showed a heterogeneous mass occupying the whole stomach cavity with extension into the third portion of the duodenum. A diagnostic of giant trichobezoar is suspected after further questioning reveling a trichotillomania, trichophagia and onychophagia. The removal of the trichobezoar endoscopically failed and it was possible to pull only few fibers of hair to comfort the diagnostic. She was subjected to an exploratory laparotomy. An antral gastrostomy were performed and a 25x10x7 cm trichobezoar was extracted. The patient had an uneventful postoperative outcome and was derived to psychiatry. Rapunzel syndrome is an uncommon trichobezoar, it’s commonly found in young females usually with an underlying psychiatric disorder. Management requires gastrotomy. A psychiatric assessment and a long-term follow-up are advocated as a regular part of treatment to prevent recurrence.

Rare case of trichobezoar causing pancreatitis in a young woman

“…Therefore, large intragastric bezoars measuring >20 cm and those with Rapunzel syndrome usually need open surgery with gastrostomy for removal 6 7. Our patient was managed in a similar approach successfully and she had an uneventful recovery period, followed by complete resolution of pancreatitis.…”

“…Additionally but less commonly, patients may present with signs of peritonitis. Bezoars can cause complications such as bleeding, ulceration, perforation, intussusception, obstructive jaundice and less commonly, protein-losing enteropathy and pancreatitis 1–7…”

“…Despite its low therapeutic yield, it remains a valuable diagnostic tool with direct visualisation in indistinguishable masses on imaging, as with our case. Other non-invasive methods such as enzymatic degradation or medical treatment have shown to be ineffective 1 2 7…”

Rapunzel Syndrome in Congenital Mental Retardation Patient Requiring Emergency Laparotomy. Case report

“…Trichobezoars tend to appear in the second decade of life [ 3 ]. Often in females with psychiatric disorders including trichotillomania (pulling out their hair) and trichophagia (eating hair) [ 7 ].…”

Giant Trichobezoar: A Rare Cause of Gastric Outlet Obstruction

“…Rarely there is extension of the hair ball from the stomach into the small intestine and colon. This condition is named Rapunzel syndrome, which was first described in 1968 by Vaughan ED, et al [30] since then fewer than hundred cases of Rapunzel syndrome have been reported in the literature [31,32].…”