Rapunzel syndrome complicated with pancreatitis, intussusception and intestinal perforation

A trichobezoar is a rare cause of abdominal pain due to an indigestible mass in the gastrointestinal tract that is composed of a patient's hair. If a trichobezoar grows and extends from the gastric body to the pylorus and into the small bowel, it is considered Rapunzel syndrome. We present a case of an 11-year-old female patient with Rapunzel syndrome who presented with four weeks of colicky abdominal pain, vomiting, constipation, and severe malnutrition. Computed tomography of the abdomen and pelvis with 3D rendering demonstrated a large bezoar, and the patient was successfully treated with exploratory laparotomy, gastrostomy, and removal of the trichobezoar intact.

Section: Discussionmentioning

confidence: 99%

Acute Case of Trichobezoar Diagnosed From Computed Tomography and 3D Images: Rapunzel Syndrome Re-examined

Kyin¹,

Patel²,

Casas-Melley³

et al. 2023

“…In our case, the mental illness was not diagnosed until she developed gastric trichobezoar. When undiagnosed in their early stages, gastric bezoars may cause gastric ulceration, perforation, hemorrhage, and obstruction [ 2 , 4 ].…”

Section: Discussionmentioning

confidence: 99%

Gastric Trichobezoar Causing Gastrointestinal Bleeding: A Case Report

Harrabi¹,

Ammar²,

Latifa³

et al. 2022

Trichobezoar is an underdiagnosed entity that has to be considered in children and adolescents, especially females, suffering from trichotillomania and trichophagia. Late diagnosis of trichobezoars showed that they cause gastrointestinal bleeding or perforation.A 17-year-old girl patient was admitted with abdominal pain and gastrointestinal bleeding. On abdominal examination, a well-defined mass in the epigastrium and the left upper quadrant was identified. Upper gastrointestinal (GI) endoscopy identified an enormous trichobezoar, which was later removed by surgery.Misdiagnosed gastric bezoars may cause life-threatening complications. Early detection for trichobezoar requires effective screening of trichotillomania. Psychiatric counseling is important to prevent bezoar recurrence.

“…Patients can present with a variety of symptoms, including abdominal pain, nausea, vomiting, fullness, difficulty swallowing, and weight loss [3]. Complications from bezoars include perforation, peritonitis, gastrointestinal obstruction, intussusception, and pancreatitis, but it largely depends on bezoar location [4,5]. The most common location is the stomach [3].…”

Section: Introductionmentioning

confidence: 99%

Gastric Outlet Obstruction and Iron Deficiency Anemia Secondary to Gastric Bezoar: A Case Report

Schofield¹,

Vazquez²,

Demuro³

et al. 2023

Trichobezoars are an accumulation of undigested hair in the gastrointestinal system. They are a rare finding and are more likely in young females. Diagnosis is largely dependent on history taking and imaging, and treatment involves the removal and psychiatric evaluation.We describe the case of a 21-year-old female with a history of gastroesophageal reflux disease (GERD) who presented with abdominal pain. Imaging showed a distended stomach with a suspected swallowed foreign substance. The patient subsequently underwent midline laparotomy, gastrotomy, and bezoar extraction. Postoperatively the patient was found to have trichotillomania, trichophagia, anxiety, depression, and symptomatic anemia. Initial management of gastric bezoars includes proper removal, but the additional follow-up needs to include psychiatric evaluation and treatment to prevent reoccurrence. It is also imperative to assess and treat underlying nutritional deficiencies.