The cause of abdominal mass in a child with celiac disease: Rapunzel syndrome. A case report

Abstract

CONTEXT: Rapunzel syndrome is a rare form of gastric trichobezoar that develops through outstretching of the bezoar from the stomach to the intestine. CASE REPORT: A 12-year-old girl who had been diagnosed with celiac disease six years earlier was brought to the department of pediatric gastroenterology because of abdominal distension. A palpable mass was detected. A trichobezoar that stretched to the small intestine was removed surgically. The patient was diagnosed as having anxiety and depressive disorder, and treatment started. Following the treatment, her previous trichophagia completely disappeared. CONCLUSION: Presence of trichobezoar should be kept in mind, especially when young girls who have psychiatric problems suffer from gastrointestinal symptoms.

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

“…Upper gastrointestinal (GI) endoscopy can provide information about the structure of the mass. The Computed tomography (CT) investigation can Reveal the existence, localization, and distribution of the bezoars [ 9 ].…”

Trichobezoar as a cause of pediatric acute small bowel obstruction

“…The smooth and slippery surface of the trichobezoar, aided by entrapped food particles and mucus, further impairs its passage through the pylorus . At least 10% of patients have a history of psychiatric disturbance, behavioral disorders, or mental retardation, and a significant proportion of cases in children were observed in association with the recent death of a family member, recent parental separation, abuse, or socioeconomic disadvantage …”

“…Open surgery therefore remains the current mainstay of treatment for this condition. Endoscopic retrieval has been described but is only successful in around 5% of cases of gastric trichobezoar, although it is slightly more effective for phytobezoar and lactobezoar . Gastric lavage and dissolution therapy using lipase, cola, and papain have also been attempted but the size and density of trichobezoars have limited the success of these methods …”

“…Endoscopic retrieval has been described but is only successful in around 5% of cases of gastric trichobezoar, although it is slightly more effective for phytobezoar and lactobezoar. 2,11 Gastric lavage and dissolution therapy using lipase, cola, and papain have also been attempted but the size and density of trichobezoars have limited the success of these methods. 4,8,16 A critical aspect of management which cannot be overlooked is secondary prevention.…”

Revisión sistemática del Síndrome de Rapunzel

“…Es una forma inusual de tricobezoar gástrico, el cual se encuentra formado por fracciones de cabello que forman un bezoar y que se pueden extender a lo largo del intestino. En este síndrome se puede observar tricofagia y tricotilomanía de manera conjunta, con trastornos depresivos, de ansiedad y particularmente, obsesivos-compulsivos (2). El síndrome de Rapunzel aparece principalmente, en mujeres jóvenes en el 90% de los casos, de los cuales el 80% son menores de 30 años (3).…”