Rapunzel syndrome reviewed and redefined

Nasogastric Tube Feeding-Induced Esophageal Bezoar: Case Description

Background. Bezoars are well established entities causing gastrointestinal obstructions. Depending on the prominent constituent of these bezoars, the latter are divided into four subtypes: pharmacobezoars, lactobezoars, trichobezoars, and phytobezoars. Less frequently reported types of bezoars are reported including those formed secondary to nasogastric tube feeding with casein-based formulas. Case Presentation. A 69-year-old male presented following cardiac arrest postmyocardial infarction. Patient sustained anoxic brain injury after resuscitation, rendering him ventilator dependant along with nasogastric tube feeding, initially. Dislodging of the nasogastric tube at one time rendered it difficult to reinsert it, with investigation showing the presence of calcified material within the distal oesophagus, mainly composed of casein-based products secondary to enteral feeding. Conclusion. Bezoars are well known to cause gastrointestinal obstructions due to their indigestible characteristics within the alimentary tract. More rare causes of bezoars include those formed from casein-based feeding formulas administered to patients with sustained enteral feeding. Esophageal obstruction, secondary to casein-based bezoars, occurs due to multiple risk factors, especially in those necessitating intensive care. Approach in such scenarios requires a multiteam approach.

A hairy situation: trichobezoar presenting with intussusception, and intestinal and biliary perforation in a child

Trichobezoars are an uncommon cause of acute abdominal pain. We present a case of a 12-year-old girl with a history of a trichobezoar who presented to the emergency department with acute abdominal pain. Abdominal sonography was performed which suggested portal venous gas and showed complex peritoneal fluid. Subsequent computed tomography demonstrated both gastric and small bowel bezoars, with a jejunojejunal intussusception, and confirmed portal venous gas and complex ascites. At the time of surgery, there was evidence of intestinal and biliary perforation. Our case illustrates a constellation of complications in association with a long-standing trichobezoar.

The diagnosis and treatment of Rapunzel syndrome

Trichobezoars are hairballs or hair-like fibers formed by chewing and swallowing hair or any other indigestible materials. Trichobezoars usually form in the gastric body and are thus prepyloric. However, trichobezoars may rarely pass through the pylorus into the duodenum, jejunum, ileum, and even the colon, in a condition referred to as Rapunzel syndrome. Here, we present a case of a 13-year-old girl with this rare syndrome and discuss the diagnosis and treatment of the disease.

Rapunzel syndrome: a rare cause of hypoproteinaemia and review of literature

Rapunzel syndrome is an extremely rare condition associated with trichophagia (hair eating disorder) secondary to a psychiatric illness called trichotillomania (hair-pulling behaviour). It is most commonly seen in children and adolescents. Untreated cases can lead to a number of complications. We present a case of a middle-aged woman with sudden intractable vomiting and constipation associated with bilateral pedal oedema and significant weight loss. Laboratory investigations revealed low serum protein levels. Laparotomy was performed, and a hairball was removed from her stomach and ileum. The patient was managed with the help of a psychiatrist and was given nutritional support. We performed a comprehensive search and summarised data for a total of 88 cases. No time or language limit was placed. The purpose of this discussion is to highlight the clinical spectrum of Rapunzel syndrome and also to report its rare association with hypoproteinaemia.

Rapunzel Syndrome: Rare 'Tale' of a Broken 'Tail'

BACKGROUND

Rapunzel syndrome is a rare and unique form of trichobezoar, in which a cast of hairs is formed in the stomach with its 'tail' extending up to varying lengths into the small bowel. Almost all cases described in literature are of 'classic' and more common form of Rapunzel. Sometimes however, the tail of bezoar is broken into smaller fragments. There is not much literature available on this rarer subset of Rapunzel syndrome.

CASE REPORT

In this report we present the ultrasound (USG) and CT findings of a case of Rapunzel syndrome in which the tail had broken into five separate fragments. The patient presented clinically with intestinal obstruction due to the impaction of the distal- most fragment in the ileum.

CONCLUSIONS

Our case highlights the fact that although USG features may be suggestive, a careful evaluation of CT images is essential for a confidant preoperative diagnosis of Rapunzel syndrome. In cases of this syndrome with a broken tail, CT is essential for precise count and localization of the separated fragments to ensure their complete removal at the time of surgery. We also propose to name the fragments of the broken tail as 'bezoarlets'. This word aptly describes the tail fragments as it suggests their origin from the larger gastric bezoar and the suffix 'lets' conveys they are smaller in size.

Laparoscopic Management of Acute Pancreatitis Secondary to Rapunzel Syndrome

A 17-year-old girl presented with bilious vomiting and abdominal pain to the surgery department. The history was positive for trichotillomania and trichophagia. A CT scan showed a mass in the stomach, which was highly suspicious for a gastric bezoar. Drooping parts of the bezoar caused a duodenal obstruction with secondary acute pancreatitis. The bezoar was removed via a laparoscopically performed gastrotomy.

Rapunzel syndrome due to ingested hair extensions: Surgical and psychiatric considerations

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Consuming hair extensions can lead to intestinal obstruction.

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Massive gastric trichobezoar extending into the duodenum is termed Rapunzel syndrome.

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Rapunzel syndrome often requires surgical intervention.

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Patients with Rapunzel syndrome require close psychiatric follow-up.

Introduction

Rapunzel syndrome is a unique clinical manifestation of trichotillomania and trichophagia. The resulting gastric trichobezoar can be massive and necessitate surgical extraction.

Presentation of case

We present a case involving a 15 year-old female with a known history of trichotillomania. The patient possessed symptoms of nausea and early satiety, and admitted that she had recently consumed a large number of hair extensions. Computed tomography imaging revealed a massive gastric bezoar not amenable to endoscopic extraction. The patient underwent surgical laparotomy, and a large gastric trichobezoar was removed through an anterior gastrotomy. The trichobezoar extended past the pylorus into the duodenum, thus confirming a diagnosis of Rapunzel syndrome.

Discussion

Trichobezoars formed from the consumption of hair extensions is a rare cause of Rapunzel syndrome. Surgical extraction is often necessitated due to the sheer size of the gastric bezoar that results from consuming hair extensions. If not previously established, psychiatric consultation should be pursued in the immediate post-operative course as these patients may require pharmacologic management along with behavioral therapy to avoid further episodes of trichotillomania.

Conclusion

This case presents a unique and modern manifestation of Rapunzel syndrome. Surgical treatment most often is required when a patient presents with a massive gastric trichobezoar. Regular post-operative psychiatric follow-up is necessary to prevent recurrent episodes.

Rapunzel syndrome

Bezoars are concretions of human or vegetable fibers that accumulate in the gastrointestinal tract. Trichobezoars are common in patients with underlying psychiatric disorders who chew and swallow their own hair. Rapunzel syndrome is a rare form of gastric trichobezoar with a long tail extending into the small bowel. This syndrome was first described in 1968 by Vaughan et al. and since then till date just 64 cases have been described in the literature. We present the only documented case with Rapunzel syndrome in Egypt.

Rapunzel syndrome presenting as jejuno-jejunal intussusception

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.

Extremely unusual case of gastrointestinal trichobezoar

Trichobezoars (hair ball) are usually located in the stomach, but may extend through the pylorus into the duodenum and small bowel (Rapunzel syndrome). Rapunzel syndrome remains uncommon; with fewer than 40 cases reported. To the best of our knowledge, this case may be the first well-documented case with a length of 75 cm. They are almost always associated with trichotillomania and trichophagia or other psychiatric disorders. In the literature several treatment options are proposed, including removal by conventional laparotomy, laparoscopy and endoscopy. Herein, we are reporting an interesting case of an 18-year mentally retarded girl with history of trichotillomania and trichophagia who presented to our emergency department with a history of central abdominal pain associated with vomiting and constipation for five days. An examination showed a trichobezoar requiring emergent surgical intervention, and indicating the need for psychiatric treatment. The trichobezoar was treated successfully by laparoscopy.

Trichobezoar, rapunzel syndrome, tricho-plaster bezoar - a report of three cases

Background

Trichobezoar is an uncommon entity observed mostly in young women. Symptoms in presenting patients are usually due to the large mass of the bezoar or malabsorption of nutrients. Trichobezoar is almost always associated with trichotillomania and trichophagia.

Case Report

Three teenage girls, aged 13, 15, and 16, were diagnosed due to palpable epigastric masses. Additionally the oldest patient presented with symptoms of ileus while the other two patients had weight loss and anaemia. Besides the 15-year-old patient complained of paroxysmal abdominal pains. Patients were subjected to plain radiographic examinations of abdomen which revealed large epigastric tumours, with additional calcifications observed in the youngest girl. Subsequent gastroscopy (the 15-year-old patient) or ultrasonographic examination and computed tomography scans (13- and 16-year-old patients) allowed to establish the diagnosis of giant bezoars: trichobezoars in two older patients and tricho-plaster bezoar in the youngest one. All the tumours were surgically resected and psychiatric treatment was undertaken.

Conclusions

1. Trichobezoar should be taken into consideration in differential diagnosis of epigastric tumours in children, especially teenage girls. 2. The conventional ultrasonographic and radiographic examinations of the abdomen are insufficient for determination of the nature of the mass. A thorough medical history interview and clinical examination may give directions regarding the further diagnosis.3. Trichotillomania and trichophagia are obsessive-compulsive disorders, and therefore patients with trichobezoars should be under psychiatric care to prevent recurrence of the disease.

Review of the diagnosis and management of gastrointestinal bezoars

The formation of a bezoar is a relatively infrequent disorder that affects the gastrointestinal system. Bezoars are mainly classified into four types depending on the material constituting the indigestible mass of the bezoar: phytobezoars, trichobezoars, pharmacobezoars, and lactobezoars. Gastric bezoars often cause ulcerative lesions in the stomach and subsequent bleeding, whereas small intestinal bezoars present with small bowel obstruction and ileus. A number of articles have emphasized the usefulness of Coca-Cola^® administration for the dissolution of phytobezoars. However, persimmon phytobezoars may be resistant to such dissolution treatment because of their harder consistency compared to other types of phytobezoars. Better understanding of the etiology and epidemiology of each type of bezoar will facilitate prompt diagnosis and management. Here we provide an overview of the prevalence, classification, predisposing factors, and manifestations of bezoars. Diagnosis and management strategies are also discussed, reviewing mainly our own case series. Recent progress in basic research regarding persimmon phytobezoars is also briefly reviewed.

Rapunzel syndrome: a rare presentation with giant gastric ulcer

The Rapunzel syndrome refers to an uncommon and rare form of trichobezoar that extends past the stomach into the small intestines. The Rapunzel syndrome is usually found in young female patients with a history of psychiatric disorders, mainly trichotillomania and trichophagia. We describe a case of Rapunzel syndrome in a 15-year-old girl who presented with abdominal pain, vomiting, and weight loss. We performed a surgical laparotomy and successfully removed a huge trichobezoar extending into the small intestine.

Rapunzel syndrome: diagnosis via radiograph and history

Rapunzel syndrome is defined as a gastric trichobezoar with a tail that extends distally into the small intestine. It is extremely rare and found more often in premenarchal girls with psychiatric comorbidities. Symptoms can be vague and linger for years. However, prolonged intake of indigestible material can lead to gastric outlet obstruction, which may present similarly to a small bowel obstruction. The standard imaging modality of choice to make a presurgical diagnosis is via computed tomography (CT) scan of the abdomen. However, the risk of radiation-induced malignancy associated with a CT scan is an important consideration when managing children. We report a case of Rapunzel syndrome in a 6-year-old girl who was diagnosed presurgically without the use of a CT scan.

Unusual trichobezoar of the stomach and the intestine: a case report

INTRODUCTION

Trichobezoars are an infrequent form of bezoar found in the stomach or intestine, created from ingested hair. This condition has been well described in the surgical literature, but less reported in psychiatry.

CASE PRESENTATION

We describe the case of an 18-year-old Middle Eastern Caucasian woman with trichotillomania who presented to our emergency department with a history of central abdominal pain associated with vomiting and constipation for five days. An examination showed a trichobezoar requiring emergent surgical intervention, and indicating the need for psychiatric treatment. The trichobezoar was treated successfully by laparotomy.

CONCLUSION

The medical and psychiatric sequelae of trichotillomania should not be underestimated, and early diagnosis and treatment is of utmost importance to save the patient's life and prevent recurrence. Although laparotomy is still considered an excellent option, pharmacotherapy and behavioral assessment play a useful role in patient management. Our case highlights the fundamental concept of a holistic approach rather than only treating the symptoms, by considering factors such as genetic influences to understand the disease.

Rapunzel Syndrome in a Postpartum Patient after Caesarian Delivery

A trichobezoar is an immobile, indigestible collection of hair or hair-like fibers that accumulates within the GI tract. Rapunzel syndrome is a rare variant in which a trichobezoar extends into the small intestine, potentially causing obstruction. We describe the first case, to our knowledge, of Rapunzel syndrome occurring in a postpartum patient after delivery by Caesarian section.

Rapunzel syndrome: a rare postpartum case

The Rapunzel syndrome describes a disorder in which a significant amount of hair is swallowed, forming a trichobezoar that extends past the stomach into the small intestines. Given the indigestible nature of hair, it subsequently leads to obstruction within the gastrointestinal system. Clinically, patients may present with symptoms of gastrointestinal obstruction, including abdominal complaints such as pain, nausea, vomiting, and diarrhea. However, due to its broad and nonspecific presenting symptoms, the diagnosis of Rapunzel syndrome warrants consideration once other common etiologies have been excluded. Surgical intervention is often required to remove the abdominal mass. This unusual syndrome is often associated with psychiatric disorders, affecting young women most commonly. In this report, we will discuss a unique case of Rapunzel syndrome in a one-month postpartum woman.

Rapunzel Syndrome Causing Appendicitis in an 8-year-old Girl

Rapunzel syndrome is a rare type of presentation of trichobezoar, an extension of hair fibers into the small bowel and rarely beyond the ileocecal valve. Its clinical presentation is deceptive ranging from abdominal mass to symptoms of obstruction. We report a 8-year-old girl admitted with a history of abdominal pain and vomiting off and on for a period of 1 year. Ultrasound findings were suggestive of subacute intestinal obstruction. On laparotomy, trichobezoar was found in the stomach extending into small bowel and was removed. Appendix was inflammed hence it was also resected. Microscopic evidence of a hair shaft was seen in the appendix indicating appendicitis was due to luminal obstruction by hair concretions.

Rapunzel Syndrome Case Report: A 13-year-old Girl

Bezoars are masses, which are commonly encountered in patients after stomach surgery or in those with psychiatric problems, formed by the accumulation of intraluminal nondigestible substances that can lead to obstruction of the stomach and the small intestine. The anatomical changes in the gastrointestinal tract are known to cause bezoar formation. In the absence of an anatomical change, psychiatric disorders such as trichotillomania may lead to the formation of trichobezoars in the stomach. The so-called Rapunzel syndrome is the extension of the bezoars down to the duodenum and the jejunum, which is a rare condition. In this paper, a 13-year-old patient with trichotillomania is reported, who was admitted to our clinic with nausea, vomiting, and fatigue complaints, in whom a giant trichobezoar was identified, which completely filled the stomach and duodenum, without causing obstruction.

A case of rapunzel syndrome

Rapunzel syndrome refers to a very rare condition in which swallowed hair forms a gastric trichobezoar that has a long tail extending into the small bowel. We describe a case of Rapunzel syndrome in an 8-year-old girl who presented with abdominal mass, epigastric pain and vomiting. Abdominal computed tomography scan showed a markedly dilated stomach filled with coarse heterogeneous materials. Upper gastrointestinal endoscopy revealed a huge hairy ball with a tail extending through the pylorus. We performed a surgical laparotomy and successfully removed a huge trichobezoar with a long tail extending into the middle portion of jejunum. Psychiatric consultation with review showed her past history of trichotillomania and trichophagia 4 years ago. But her parents denied further psychiatric therapy and she was lost to the follow-up. Rapunzel syndrome should be included in the differential diagnosis in children with chronic abdominal pain and trichophagia.

Gastric electrical stimulation for the treatment of obesity: from entrainment to bezoars-a functional review

GROWING WORLDWIDE OBESITY EPIDEMIC HAS PROMPTED THE DEVELOPMENT OF TWO MAIN TREATMENT STREAMS: (a) conservative approaches and (b) invasive techniques. However, only invasive surgical methods have delivered significant and sustainable benefits. Therefore, contemporary research exploration has focused on the development of minimally invasive gastric manipulation methods featuring a safe but reliable and long-term sustainable weight loss effect similar to the one delivered by bariatric surgeries. This antiobesity approach is based on placing external devices in the stomach ranging from electrodes for gastric electrical stimulation to temporary intraluminal bezoars for gastric volume displacement for a predetermined amount of time. The present paper examines the evolution of these techniques from invasively implantable units to completely noninvasive patient-controllable implements, from a functional, rather than from the traditional, parametric point of view. Comparative discussion over the available pilot and clinical studies related to gastric electrical stimulation outlines the promises and the fallacies of this concept as a reliable alternative anti-obesity strategy.

Diospyrobezoar as a cause of small bowel obstruction

Phytobezoar, a concretion of indigestible fibers derived from ingested vegetables and fruits, is the most common type of bezoar. Diospyrobezoar is a subtype of phytobezoar formed after excessive intake of persimmons (Diospyros kaki). We report the case of a diabetic man with a 5-day history of abdominal pain after massive ingestion of persimmons who developed signs of complicated small bowel obstruction. The patient had a previous history of Billroth II hemigastrectomy associated with truncal vagotomy to treat a chronic duodenal ulcer 14 years earlier. Since intestinal obstruction was suspected, he underwent emergency laparotomy that revealed an ileal obstruction with small bowel perforation and local peritonitis due to a phytobezoar that was impacted 15 cm above the ileocecal valve. After segmental intestinal resection, the patient had a good recovery and was discharged on the 6th postoperative day. This report provides evidence that diospyrobezoar should be considered as a possible cause of small bowel obstruction in patients who have previously undergone gastric surgery.

Trichobezoar causing pancreatitis: first reported case of Rapunzel syndrome in a boy in North America

Trichobezoar is a mass of hair retained in the stomach, usually associated with trichotillomania. Large trichobezoars may extend into the small bowel and cause small bowel obstruction or pancreatic dysfunction, a condition known as Rapunzel syndrome. Here we report the first North American case of Rapunzel syndrome in a male patient.

Tricholithobezoar causing gastric perforation

A bezoar is an intraluminal mass formed by the accumulation of undigested material in the gastrointestinal tract. Trichobezoar is a rare condition seen almost exclusively in young women with trichotillomania and trichotillophagia. When not recognized, the trichobezoar continues to grow, which increases the risk of severe complications such as gastric ulceration and even perforation. Formation of a gallstone within the trichobezoar (tricholithobezoar) is an event that has not yet been described. We report the case of a 22-year-old woman admitted to the emergency room with signals and symptoms of an epigastric mass and perforative acute abdomen. Radiological study revealed bilateral pneumoperitoneum. Personal history revealed depressive syndrome, trichotillomania and trichophagia. With a diagnosis of visceral perforation, an urgent exploratory laparotomy was performed. This confirmed the diagnosis of gastric perforation due to a large trichobezoar with the formation of a gastrolith that was removed by anterior gastrotomy. Biochemical study of the gastric stone revealed that it was composed of bile salts. There were no complications. The patient was discharged on the 5th postoperative day and was referred for psychiatric treatment.

A Hairy Tail not a Fairy Tale - Rapunzel Syndrome

Rapunzel syndrome is an unusual and rare type of trichobezoar. Bezoars can be classified according to the primary constituent, as trichobezoar (hair), phytobezoar (plant material) or miscellaneous (pharmacobezoar, lactobezoar, fungal agglomeration and foreign bodies). When a long tail of hair strands extends from the main mass in the stomach along the small intestine and beyond it is known as Rapunzel syndrome. Here we are reporting a case of Rapunzel syndrome with a very long tail who was managed successfully. And reviewing the literature on the pathophysiology and management of these patients. These patients commonly present with obstructive symptoms and needs a high index of suspicion especially, in young female patients who have alopecia circumscripta and underlying psychiatric disorders. Early diagnosis and treatment is required to prevent complications due to this condition. Currently surgical management of this condition is the treatment of choice.

The Rapunzel syndrome: a hard-to-swallow tale

INTRODUCTION

Rapunzel syndrome is a rare entity comprising of a large gastroduodenal trichobezoar due to trichotillomania. Its treatment is often surgical.

CASE REPORT

A 27-year-old patient was investigated after an upper gastro-intestinal tract obstruction. Computed tomography and endoscopy showed a large gastric trichobezoar with a duodenojejunal tail. Conservative treatments failed to remove the bezoar. We performed a short laparotomy which allowed the removal of the bezoar through a longitudinal gastrotomy. Postoperative course was uneventful.

An unusual case report of rapunzel syndrome trichobezoar in a 3-year-old boy

Rapunzel Syndrome is a rare trichobezoar, involving strands of swallowed hair extending as a tail through the duodenum, beyond the stomach. Trichobezoar usually occur in patients with history of trichotillomania, characterized by compulsive behavioral disorder of pulling own hairs, combined with trichophagia that consists of ingesting that hairs. It typically occurs in stomach and rarely affects the small intestine. Trichobezoars are more common in adolescent females. Common presentation is gastrointestinal tract obstruction with nausea and vomiting, gut perforation, acute pancreatic necrosis, obstructive jaundice, hypochromic anemia, vitamin B12 deficiency, weight loss, an abdominal mass, or other serious problems. Intestinal obstruction due to trichobezoar is extremely rare. We are here reporting a large trichobezoar in a 3-year-old male child who presented to the emergency department with thread protruding from mouth with no sign of hair loss on body.

Gastric trichobezoar causing intermittent small bowel obstruction: report of a case and review of the literature

We report the unusual case of a 45-year-old woman who presented with multiple episodes of small bowel obstruction. Initial exploratory lap-roscopy did not reveal an etiology of the obstruction. Subsequent upper endoscopy identified a non-obstructing gastric trichobezoar which could not be removed endoscopically but was not thought to be responsible for the small bowel obstruction given its location. One week postoperatively, the patient experienced recurrence of small bowel obstruction. Repeat endoscopy disclosed that the trichobezoar was no longer located in the stomach and upon repeat laparotomy was extracted from the mid-jejunum. In the following 8 months, the patient had no further episodes of small bowel obstruction. Consequently, gastric bezoars should be included in the differential diagnosis of recurrent small bowel obstruction.

Rapunzel Syndrome: A Case Report

Rapunzel syndrome is a rare type of trichobezoar with extension of the hair into the small bowel. Clinical presentation can be deceptive ranging from upper abdominal mass to gastrointestinal obstructive symptoms. In majority of cases, the diagnosis is made very late in the history of the disease due to late patient presentation in lieu of his underlying mental disorder. Surgical removal is necessary. One such case is describe here stressing the importance of imaging in the diagnosis of this condition.

Rapunzel syndrome — a case report

Bezoars 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.

Management of trichobezoar: case report and literature review

Trichobezoars (hair ball) are usually located in the stomach, but may extend through the pylorus into the duodenum and small bowel (Rapunzel syndrome). They are almost always associated with trichotillomania and trichophagia or other psychiatric disorders. In the literature several treatment options are proposed, including removal by conventional laparotomy, laparoscopy and endoscopy. We present our experience with four patients and provide a review of the recent literature. According to our experience and in line with the published results, conventional laparotomy is still the treatment of choice. In addition, psychiatric consultation is necessary to prevent relapses.

The rapunzel syndrome: an unusual trichobezoar presentation

The Rapunzel syndrome is an unusual form of trichobezoar found in patients with a history of psychiatric disorders, trichotillomania (habit of hair pulling) and trichophagia (morbid habit of chewing the hair), consequently developing gastric bezoars. The principal symptoms are vomiting and epigastric pain. In this case report, we describe this syndrome in a young girl.

Rapunzel syndrome and gastric perforation

Rapunzel syndrome complicated with gastric perforation is a very rare presentation of trichobezoar. Trichobezoar is an uncommon condition affecting predominantly females. It has non-specific clinical presentation, a wide range of complications, and, if not treated appropriately, carries significant mortality. Traditional treatment of trichobezoar is surgical, though, attempts have been made to excise endoscopically, dissolve chemically or fragment using extracorporeal shock waves. We report a case of a very large trichobezoar occupying most of the stomach and duodenum complicated with gastric perforation, and summarise the literature regarding trichobezoar aetiology, diagnostic difficulties, and management.

Rapunzel syndrome: a comprehensive review of an unusual case of trichobezoar

An unusual form of bezoar extending from the stomach to the small intestine or beyond has been described as Rapunzel syndrome. Bezoars are concretions in the gastrointestinal tract that increase in size by continuous accumulation of non-absorbable food or fibers. Most bezoars in children are trichobezoars from swallowed hair from the head, dolls, or brushes. Trichobezoars typically cause abdominal pain and nausea, but can also present as an asymptomatic abdominal mass, progressing to abdominal obstruction and perforation. Trichobezoar with Rapunzel syndrome is an uncommon diagnosis in children with less than 40 cases reported. It is predominantly found in emotionally disturbed or mentally retarded youngsters. We present the youngest case of Rapunzel syndrome in the United States, a 5-year-old girl with mental retardation who presented with abdominal pain, vomiting and a non-tender abdominal mass.

The Rapunzel syndrome: is it an Asian problem? (case report and review of literature)

Trichobezoars are intraluminal accretions of ingested hair. The Rapunzel syndrome is a rare form of gastric trichobezoar, with extension into the small bowel, and may be complicated by obstruction, perforation or peritonitis. The majority of reported cases are from Asian countries. We describe the second case from England who, like the earlier report, is also a 14-year old Asian girl who presented with small bowel obstruction. The pathology was missed 2 years previously when she presented with slim stature, iron-deficiency anaemia and frontal alopecia. This report highlights the need for a higher index of suspicion, particularly in Asian girls to avoid missing the diagnosis and early elective intervention.