Hair Apparent: Rapunzel Syndrome

Abstract

Emily (all names and identifiers have been changed to protect confidentiality) was a 7-year-old girl seen by her pediatrician for a routine annual examination. Although Emily had voiced no complaints, her mother had noted that she had appeared paler than usual. Upon physical examination, her pediatrician noted a nontender palpable mass in the child's stomach, leading him to order an abdominal ultrasound. The study showed no evidence of any abnormalities, although the technician did note that Emily must have just eaten because her stomach was full. However, her mother reported that Emily had not eaten since breakfast, 4 hours earlier.On reevaluation the next day, Emily's pediatrician still palpated the same mass, leading him to order a computed tomography (CT) scan of the abdomen. The abdominal CT demonstrated a free-floating mass that filled the entire stomach and was surrounded by a thin rim of contrast material (Figure 1). Emily's pediatrician did not think the mass was consistent with a neoplasm but was concerned that it could be a conglomeration of something she had ingested. Upon further questioning, Emily reported no stomach pain, nausea, vomiting, reflux, diarrhea, flatulence, recent illnesses, or fever. Her mother reported no change in her bowel habits and stated that Emily never wanted to eat much in one sitting.Given the large size and appearance of the mass on tomography, a decision was made to remove it surgically. Just as the elective surgery was scheduled, Emily was referred for evaluation by the child psychiatry consultation-liaison team. Initial Psychiatric ConsultationThe child psychiatry team (A.S.F. and A.M.) met with Emily and her mother the morning before surgery. By her own and her mother's account, she was happy and well adjusted. She had many friends and was enrolled in a mainstream public school second-grade class that she enjoyed.Emily lived in the home of a family friend with her mother (Kim), her older half sister, and her younger brother. Up until 2 years before, Emily had lived with her mother, siblings, and father in their own home. Kim felt that family life had been generally good during the marriage and that her husband had been a good father; Emily was especially close to him. Emily's father, however, had a substance abuse problem that led to dissolution of the marriage 2 years before admission. After this, the parents' relationship became strained, and Emily had not seen her father in a year.Emily was briefly in counseling to help her deal with the changes in her life surrounding her parents' separation, but the counselor felt that she was coping well and did not require further psychotherapy. Kim, however, expressed private concern that Emily was not dealing with the loss of her father. Meanwhile, Emily had started at a new school and was doing well academically and socially. With this background information, further evaluation was deferred until after the surgery, when the identity of the mass would be elucidated. Surgical ProcedureBecause the mass in Emily's stomach appeared ...

Trichobezoar in the absence of trichotillomania: a consequence of occupational hazard

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Epônimos e o consórcio intelectual entre ciência e literatura

“…Uma vez que os movimentos peristálticos não eliminam por completo os fios de cabelo, o material se acumula e forma uma longa trança no estô-mago e duodeno -as "tranças de Rapunzel". Cerca de 1% dos pacientes necessitam de cirurgia para remoção da massa de cabelos (tricobezoar) que se forma no estômago e duodeno (FREY et al, 2005); restos de alimento ficam retidos no emaranhado de cabelos, facilitando a proliferação de bacté-rias e complicações intestinais. Além dos problemas nutricionais e dos riscos de graves infecções, as imagens tomográficas do tricobezoar às vezes induzem falsos diagnósticos de neoplasma, para desespero dos pais.…”