Laparoscopic Management of Acute Pancreatitis Secondary to Rapunzel Syndrome

Koushk‐Jalali, Bijan; Bingöl, Alperen S.; Reyad, Ashraf

doi:10.1155/2016/7638504

Cited by 8 publications

(7 citation statements)

References 17 publications

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“…However, attempts at endoscopic removal were successful in only 2 out of 40 cases (5%) 1. This is due to the size and hardness of the trichobezoar which is difficult to fragment and may cause further fragment migration 3 8 9. Despite its low therapeutic yield, it remains a valuable diagnostic tool with direct visualisation in indistinguishable masses on imaging, as with our case.…”

Section: Discussionmentioning

confidence: 69%

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Rare case of trichobezoar causing pancreatitis in a young woman

et al. 2019

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This is a case of a 14-year-old woman diagnosed with acute pancreatitis based on history and laboratory investigations. CT scan confirmed the diagnosis of acute pancreatitis along with the presence of two bezoars in the stomach and proximal jejunum. Gastroscopy showed a large trichobezoar with difficult endoscopic extraction. Accordingly, the patient underwent laparotomy, gastrostomy and enterotomy with successful removal of the large gastric and jejunal daughter bezoars. Following surgery, pancreatitis resolved and investigations returned to normal. Child psychiatry consultation was sought, and she was diagnosed with trichotillomania and trichophagia.

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Section: Discussionmentioning

confidence: 69%

“…Laparoscopic approach is technically challenging, requires longer operative time, and spillage of hair into the abdominal cavity remains of concern. On the other hand, it provides less scarring, shorter hospital stay and fewer complications 1 8–10…”

Section: Discussionmentioning

confidence: 99%

Rare case of trichobezoar causing pancreatitis in a young woman

et al. 2019

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“…RS is a unique manifestation of an advanced gastric trichobezoar, first described in literature by Vaughn et al in 1968. RS has three standard features: (i) trichobezoar in the stomach, (ii) long hair strands that extend from the stomach to the small intestine and sometimes the large bowel and (iii) gastrointestinal symptoms [ 7 ]. It is typically asymptomatic until the bezoar reaches a substantial size, which leads to abdominal discomfort (37%), weight loss and anorexia (38%), later developing into nausea or postprandial vomiting (38%) and abdominal cramps [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Successful laparoscopic extraction of trichobezoar due to Rapunzel syndrome: first reported case in Kuwait

Almulla

Altabeekh

Al-Jafar

et al. 2021

Journal of Surgical Case Reports

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Rapunzel syndrome is a rare condition typically found in young female patients with mental or psychiatric disorders. It manifests as a large trichobezoar extending beyond the pylorus into the small intestine and leads to various adverse conditions. Early diagnosis and prompt management are crucial to avoiding complications. These bezoars are extracted endoscopically, laparoscopically and via open surgery (most common). In this current report, we discuss a successful laparoscopic extraction of a trichobezoar in a 12-year-old girl with acute abdominal pain due to small-bowel obstruction. We describe our technique compared with others’ techniques and include a literature review on this topic.

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“…In these 10 articles, there were 11 cases of duodenal obstruction caused by bezoar. Among these 11 cases, 2 cases were so-called Rapunzel Syndrome (caused by trichobezoar) [ 3 , 4 ], 1 case was bezoar resulting from industrial material [ 8 ], and other 9 cases were phytobezoar [ 2 , 5 – 7 , 9 – 11 ]. The location of bezoars were as follows: 6 for first portion [ 3 , 6 , 7 , 9 – 11 ], 2 for second portion [ 7 , 8 ], 1 for third portion [ 2 ], 1 for diverticulum of the duodenum [ 5 ], and 1 for entire duodenum [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Obstruction in the third portion of the duodenum due to a diospyrobezoar: a case report

et al. 2017

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BackgroundDuodenal obstruction occurs mainly due to physical lesions such as duodenal ulcers or tumors. Obstruction due to bezoars is rare. We describe an extremely rare case of obstruction in the third portion of the duodenum caused by a diospyrobezoar 15 months after laparoscopic distal gastrectomy for early gastric cancer.Case presentationA 73-year-old man who underwent laparoscopic distal gastrectomy for early gastric cancer 15 months before admission experienced abdominal distension and occasional vomiting. The symptoms worsened and ingestion became difficult; therefore, he was admitted to our department. Computed tomography (CT) performed on admission revealed a solid mass in the third portion of the duodenum and dilatation of the oral side of the duodenum and remnant stomach. Esophagogastroduodenoscopy (EGD) revealed a bezoar deep in the third portion of the duodenum. We could neither remove nor crush the bezoar. At midnight on the day of EGD, he experienced sudden abdominal pain. Repeat CT revealed that the bezoar had vanished from the duodenum and was observed in the ileum. Moreover, small bowel dilatation was observed on the oral side of the bezoar. Although CT showed neither free air nor ascites, laboratory data showed the increase of leukocyte (8400/μL) and C-reactive protein (18.1 mg/dL), and abdominal pain was severe. Emergency surgery was performed because conservative treatment was considered ineffective. We tried advancing the bezoar into the colon, but the ileum was too narrow; therefore, we incised the ileum and removed the bezoar. The bezoar was ocher, elastic, and hard, and its cross-section was uniform and orange. The postsurgical interview revealed that the patient loved eating Japanese persimmons (Diospyros kaki); therefore, he was diagnosed with a diospyrobezoar. His postoperative progress was good and without complications. He left the hospital 10 days after surgery. EGD performed 4 weeks after surgery revealed no abnormal duodenal findings.ConclusionsWe describe a rare case of obstruction in the third portion of the duodenum caused by a diospyrobezoar 15 months after laparoscopic distal gastrectomy with Billroth I reconstruction for early gastric cancer.

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Laparoscopic Management of Acute Pancreatitis Secondary to Rapunzel Syndrome

Cited by 8 publications

References 17 publications

Rare case of trichobezoar causing pancreatitis in a young woman

Rare case of trichobezoar causing pancreatitis in a young woman

Successful laparoscopic extraction of trichobezoar due to Rapunzel syndrome: first reported case in Kuwait

Obstruction in the third portion of the duodenum due to a diospyrobezoar: a case report

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