Rapunzel Syndrome of a Cotton Bezoar in a Multimorbid Patient

Emre, Arif; Taşçılar, Öge; Karadeniz, Güldeniz; İrkörücü, Oktay; Karakaya, Kemal; Comert, Mustafa

doi:10.1590/s1807-59322008000200021

Cited by 13 publications

(20 citation statements)

References 6 publications

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“…It can be composed of vegetable fibers (phytobezoar), medications (pharmacobezoar), undigested milk (lactobezoar) or foreign material such as hair (trichobezoar) [1,2]. Trichobezoars, unlike other bezoars are not associated with alterations in gastrointestinal motility [2].…”

Section: Discussionmentioning

confidence: 99%

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Small Intestinal Obstruction Secondary to Jejunal Trichobezoar Removed Per Anum Without an Enterotomy: A Case Report

Adhikari

Vankipuram

Tiwari

et al. 2015

JCDR

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A 29-year-old woman presented to the emergency room with complaints of abdominal pain for five days, multiple episodes of vomiting, mild fever for two days and mild abdominal distention. On examination abdomen was soft with mild tenderness and distention. There was no palpable mass and hyperperistaltic bowel sounds were present. Per rectal examination showed soft stools. Routine blood investigations were normal. Naso gastric drainage was bilious around 100 ml on insertion. An erect plain X-ray of the abdomen showed few gas filled small bowel loops with a few air fluid levels. Ultrasound examination of the abdomen revealed multiple minimally dilated fluid filled bowel loops. Computerised tomograhy of the abdomen showed dilatation of small bowel loops 4 -5 cm in diameter with transistion point seen at the level of proximal ileum. The large bowel distally appeared collapsed [ ABSTRACTTrichobezoars can rarely present with obstruction. This is usually due to collection of a hair ball in the stomach. We encountered an interesting case of small bowel obstruction due to a jejunal trichobezoar. The treatment generally is an enterotomy with removal of the hair ball. We report a case of a 29-year-old post partum female who presented to us with sub acute intestinal obstruction. Exploratory laparotomy revealed an impacted mass in the distal jejunum which was removed per anum without an enterotomy. Postoperative gastroscopy did not show trichobezoar in the stomach. This case highlights the importance of trichobezoar as a differential diagnosis in young women with small bowel obstruction that can be treated without an enterotomy and avoiding the risks and morbidities associated with it.

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Section: Discussionmentioning

confidence: 99%

“…Trichobezoars, unlike other bezoars are not associated with alterations in gastrointestinal motility [2]. Trichobezoars are almost exclusively seen in women with only isolated cases reported in males usually occurring between the age group of 13-20 [1,2]. They often coexist with underlying learning disabilities or psychiatric illness [2].…”

Section: Discussionmentioning

confidence: 99%

Small Intestinal Obstruction Secondary to Jejunal Trichobezoar Removed Per Anum Without an Enterotomy: A Case Report

Adhikari

Vankipuram

Tiwari

et al. 2015

JCDR

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“…Patients are usually asymptomatic until trichobezoars reach a critical size [2]. The clinical picture includes abdominal pain, nausea, vomiting, early satiety, and weight loss.…”

Section: Discussionmentioning

confidence: 99%

“…The clinical picture includes abdominal pain, nausea, vomiting, early satiety, and weight loss. In cases of the Rapunzel syndrome, a tail in the intestines can trigger peristaltic movements, resulting in colicky abdominal pain [2]. Naik et al in their review presented the most common features of Rapunzel syndrome: abdominal pain (37%); nausea and vomiting (33,3%); obstruction (25,9%); and peritonitis (18,3%).…”

Section: Discussionmentioning

confidence: 99%

“…Bezoars are classified according to the content of the bezoar, such as trichobezoars (composed of hairs and synthetic fibers), phytobezoars (vegetable fibers, seeds, and skin of vegetables), trichophytobezoar (a combination of both), lactobezoars (milk products), lithobezoars (concretion of mud and stone), and pharmacobezoars (medication impaction) [2]. Trichobezoars are the most common form of bezoars (55% of all bezoars) [3,4].…”

Section: Introductionmentioning

confidence: 99%

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Rapunzel syndrome — a case report

et al. 2010

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AbstractBezoars are collections of indigestible materials found in the gastrointestinal tract. Rapunzel syndrome is a rare complication of a gastric trichobezoar in which the mass of hair extends through the pylorus into the small bowel and can even reach the colon. A 12-year-old girl with severe pain and a feeling of “fullness” in the upper abdomen was admitted to Pediatric Surgery. Two days before admission, the patient presented with vague abdominal pain, vomiting with a little blood, and black stool. On physical examination she was pale and listless with patchy alopecia. Abdominal examination showed a mobile, palpable mass in the epigastrium. The initial hematocrit was 7,1%, and the erythrocyte count was 1,12×1012 cells per liter. Abdominal ultrasound and computed tomographic (CT) examinations confirmed the presence of a tumor-like formation in stomach. A giant bezoar with ulceration on the back wall of the stomach was verified by upper gastrointestinal endoscopy. Endoscopic extraction was not possible because of the size of the bezoar. Gastrotomy was performed to remove the bezoar that occupied most of the stomach, with a long tail that extended deeply into the duodenum (Rapunzel syndrome). The bezoar, 35 by 10 cm in diameter, was black and consisted of hair and synthetic fibers. Prompt diagnosis and treatment of trichobezoars are important to avoid a possible fatal outcome.

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