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

Abstract

Introduction When hair accumulates inside the stomach, it causes what is called a Trichobezoar, which leads to a stomach blockage. When the accumulated hair extends into the small intestine, it causes a rare disturbance called Rapunzel syndrome (RS). Discussion Affected patients infrequently remain asymptomatic for several years. Symptoms begin while the bezoar increases in size to the point of obstruction, these symptoms are nonspecific like vomiting, nausea, anorexia, asymptomatic abdominal mass and digestive bleeding. Presentation of case The authors report an unusual case of a 25 years old young woman who presented with acute abdominal pain and gastrointestinal symptoms. With an upper gastroscopy, the condition was first diagnosed as a Trichobezoar that occupied the stomach. A decision to perform a surgical procedure was taken, only to discover, during the procedure, that the mass was extended to the duodenum and jejunum, thus diagnosing the condition as Rapunzel syndrome. The patient was managed by surgical removal of the huge mass. Conclusion Trichobezoar considers as a differential diagnosis for any patient with mental retardation and has gastrointestinal symptoms.

Trichobezoar: A case report of a double gastric and ilial localization revealed by an occlusion

“…Endoscopic extraction represents a second therapeutic approach and the first endoscopic ablation of a trichobezoar was attempted 20 years ago [2] , [3] , [9] .The latest review of the endoscopic treatment of trichobezoar published in 2020 and including 47 articles showed the success of endoscopic treatment for 16 patients out of 52 patients (30.7%) [4] . The success of endoscopic treatment is conditioned by the size of the obstacle which must not exceed 7 cm of long axis and its weight which must not exceed 55 g, a preferred esophageal or gastric seat, the absence of Rapunzel syndrome and the experience of the treating physician [3] .…”

“…The stomach tends to be the typical location. In some cases there is an extension to the duodenum, jejunum or even to the colon and it is called Rapunzel syndrome [4] . The double localization of trichobezoars, which is the case of our patient, is considered for some authors as part of Rapunzel syndrome but remains a separate entity for others [4] .…”

“…In some cases there is an extension to the duodenum, jejunum or even to the colon and it is called Rapunzel syndrome [4] . The double localization of trichobezoars, which is the case of our patient, is considered for some authors as part of Rapunzel syndrome but remains a separate entity for others [4] . This pathology is found especially in young adolescent women with a history of psychiatric disorders [1] , [2] .…”