Rapunzel syndrome: A rare presentation with multiple small intestinal intussusceptions

Prasanna, Bidarahalli Krishna; Sasikumar, K; Gurunandan, Uppinakudru; Sreenath, G; Kate, Vikram

doi:10.4240/wjgs.v5.i10.282

Cited by 20 publications

(18 citation statements)

References 6 publications

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“…[7] Trichophagia and trichobezoar are abundantly described in surgical literature. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] In few cases, no evidence of trichotillomania was found in patients presenting with trichobezoar. [4,9] Previous reports of trichobezoar have also reported co-occurrence of eating hairs and other non-eatable items amounting to pica.…”

Section: Discussionmentioning

confidence: 99%

Trichophagia along with trichobezoar in the absence of trichotillomania

Mehra

Gupta

Grover

2014

Journal of Neurosciences in Rural Practice

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Trichobezoars are rarely described in the absence of trichotillomania. In this report we present a case of trichobezoar associated with trichophagia in the absence of trichotillomania. A 16-year-old girl presented to surgery outpatient with complaints of pain in abdomen and vomiting for the last 6 months. Physical examination revealed a 14 × 16 cm firm, tender, mass with smooth surface, irregular margins, which was mobile with respiration. Ultrasound abdomen revealed a bizarre lesion in the right upper and middle abdomen suggestive of gastric bezoars. Upper gastrointestinal endoscopy did not reveal any abnormality in the esophagus and showed a large mobile mass in the stomach. In view of trichobezoar, psychiatry consultation was sought. Exploration of history revealed that the patient was eating hairs and clay since early childhood. As per patient she would eat hairs thrown by others. She would like the taste of hair and had strong persistent desire to eat hair and would go out searching for the same. At times she would also eat clay. However, she denied of pulling her own hairs. Physical examination of scalp and other body parts did not show any evidence of alopecia or pulling of hair/short hair. She was managed surgically and was counseled about the consequences of eating hairs and clays and was encouraged not to eat hair. To conclude our case suggests that patients can have trichobezoar and trichophagia even in the absence of trichotillomania.

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Section: Discussionmentioning

confidence: 99%

Trichophagia along with trichobezoar in the absence of trichotillomania

Mehra

Gupta

Grover

2014

Journal of Neurosciences in Rural Practice

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“…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 one report of intussusception occurring with Rapunzel syndrome in an adolescent patient, removal of the long tail was possible through gastrotomy alone, as was observed in the present case [15]. However, in the earlier report, the diagnosis of intussusception was made only after exploration, unlike our case, where diagnosis was made on preoperative CT scan.…”

Section: Discussionmentioning

confidence: 45%

Rapunzel syndrome presenting as jejuno-jejunal intussusception

Marwah

Pandey

Raj

et al. 2015

Clin J Gastroenterol

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The term Rapunzel syndrome is used to describe a trichobezoar of the stomach with a long tail of hair extending into the duodenum and small intestine. It is a rare clinical entity, and it is even rarer in these cases that jejuno-jejunal intussusception and resulting intestinal obstruction is a presenting feature. We report one such case, a young female who presented in the emergency department with abdominal pain and bilious vomiting of short duration. Contrast-enhanced CT of the abdomen enabled a diagnosis of a trichobezoar in the stomach extending into the small gut, along with jejuno-jejunal intussusception. On exploration, gastrotomy was performed to remove the gastric trichobezoar, and jejuno-jejunal intussusception was found on three segments in the proximal jejunum, which was resolved upon complete removal of the tail of the bezoar. This case report is unusual, since intussusception is a rare occurrence in Rapunzel syndrome, and this is the first time that it has been diagnosed preoperatively.

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“…7 Prasanna et al reported a case of Rapunzel syndrome from trichobezoar, with multiple small intestinal intussusceptions which were manually reduced at surgery. 8 Anantha et al reported a similar case in a 9-year-old boy, who had a gastrostomy and multiple enterotomies to retrieve a thick bezoar causing long segment of ileal intussusception. 9 Although a bezoar is not inherently attached to the bowel wall, it seems to incite small bowel intussusception.…”

Section: Discussionmentioning

confidence: 94%

“…5,6 Intussusception as a complication of bezoar has also been rarely described in the literature, usually associated with bowel obstruction. 7,8 It has been postulated that the tail of the bezoar and the intraluminal strands interfere with the small bowel peristalsis and hence predispose to intussusception. 9 It is also possible that a purse-string effect due to shorter length of the bezoar tail, compared with the length of the small intestine, may lead to foreshortening and contraction of the mesenteric side of the small bowel wall, leading to intussusception.…”

Section: Introductionmentioning

confidence: 99%

Rapunzel Syndrome and Small Bowel Intussusceptions Due to a Cotton Thread Bezoar: A Case Report

Raghu

Nagadi

Kumar

2018

Journal of Gastrointestinal and Abdominal Radiology

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Rapunzel syndrome is a rare disease in which a trichobezoar extends into the duodenum or distal small intestine. It is associated with compulsive eating of indigestible substances or pica and is more common in cases of underlying psychiatric disturbances. If left untreated, gastrointestinal bezoars with or without the Rapunzel syndrome may lead to several complications such as ulceration, perforation, peritonitis, pancreatitis, biliary obstruction, severe nutritional disturbances, and rarely intestinal obstruction. We present an exceptionally rare case of Rapunzel syndrome caused by a large cotton thread bezoar in an adolescent girl, associated with multiple jejunal intussusceptions. Further, we present a literature review of this entity. An interesting association of bezoar with intussusception is explained. Since a history of pica may not be forthcoming in all cases, it is important to be familiar with the imaging characteristics, complications, and management of bezoars. AbstractKeywords ► intussusception ► Rapunzel syndrome ► trichobezoar

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Rapunzel syndrome: A rare presentation with multiple small intestinal intussusceptions

Cited by 20 publications

References 6 publications

Trichophagia along with trichobezoar in the absence of trichotillomania

Trichophagia along with trichobezoar in the absence of trichotillomania

Rapunzel syndrome presenting as jejuno-jejunal intussusception

Rapunzel Syndrome and Small Bowel Intussusceptions Due to a Cotton Thread Bezoar: A Case Report

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