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Liang Y, Huang L, Wang D, Liu T, Li X, Wang W, Shen Q, Han J, Li S, Wang L, Chen L. Rapunzel syndrome in children: a retrospective review of ten cases combined with literature review in a tertiary referral center. Pediatr Surg Int 2024; 40:121. [PMID: 38703237 DOI: 10.1007/s00383-024-05705-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE Rapunzel syndrome is an uncommon condition in children, and its clinical features remain unclear. This study presents the largest single-center series of pediatric cases to date, with the objective of documenting the clinical characteristics and treatment approaches for children with Rapunzel syndrome. METHODS A retrospective study was conducted in children with Rapunzel syndrome from 2019 to 2023. We recorded age, gender, symptoms, locations of bezoar, complications, and treatment options. RESULTS Ten patients with Rapunzel syndrome were included. The median age was 9.1 years, with all of whom were female. The most common clinical symptoms were upper abdominal mass (90%), abdominal pain (80%), and nausea and vomiting (50%). Complications occurred in six cases (60%), including small bowel obstruction (20%), severe gastric dilatation (10%), intestinal perforation (10%), choledochodilation (10%), acute pancreatitis with cholecystitis (10%). Preoperative ultrasonography suggested low-echoic foreign bodies continuing to the jejunum or ileocecal region in five cases (50%). Preoperative gastroscopy attempted in four cases (40%) to remove the foreign bodies, all of which failed. All patients underwent surgical treatment, with nine cases undergoing gastric incision foreign body removal, and one case undergoing gastric incision foreign body removal combined with intestinal perforation repair. All patients recovered well. No recurrence was observed during follow-up. CONCLUSION The accuracy of ultrasound diagnosis in identifying Rapunzel syndrome is high; however, it may lead to misdiagnosis if not complemented with the patient's medical history. Endoscopic presents a heightened treatment risk and a reduced success rate. The condition commonly presents with severe complications, thus making laparotomy a safe and effective option for intervention.
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Affiliation(s)
- Yiyuan Liang
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Liuming Huang
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China.
| | - Dayong Wang
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Tingting Liu
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xianling Li
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Qiulong Shen
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jinbao Han
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Shuanling Li
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Li Wang
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Long Chen
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
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Au VA, Wong JP, Venu I, Moodie RG, Etoom Y, Kieswetter L, Gerstle JT, Wong PD. Failing to thrive, abdominal pain and vomiting: A hairy situation. Paediatr Child Health 2018; 23:173-175. [PMID: 29773958 DOI: 10.1093/pch/pxx210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Victoria A Au
- Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Jonathan P Wong
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario.,Department of Paediatrics, Hospital for Sick Children, Dublin, Irel
| | - Isvarya Venu
- Trinity College, University of Dublin, Dublin, Irel
| | - Rosemary G Moodie
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario.,Department of Paediatrics, Hospital for Sick Children, Dublin, Irel
| | - Yousef Etoom
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario.,Department of Paediatrics, Hospital for Sick Children, Dublin, Irel.,Department of Paediatrics, St. Joseph's Health Centre, Toronto, Ontario
| | - Luke Kieswetter
- Department of Paediatrics, McMaster University, Toronto, Ontario
| | - J Ted Gerstle
- Department of Surgery, Hospital for Sick Children, Toronto, Ontario
| | - Peter D Wong
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario.,SickKids Research Institute, Toronto, Ontario
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Ullah W, Saleem K, Ahmad E, Anwer F. Rapunzel syndrome: a rare cause of hypoproteinaemia and review of literature. BMJ Case Rep 2016; 2016:bcr-2016-216600. [PMID: 27671985 DOI: 10.1136/bcr-2016-216600] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
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.
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Affiliation(s)
| | | | - Ejaz Ahmad
- Department of Medical Education, Griffin Hospital, Derby, Connecticut, USA
| | - Faiz Anwer
- Department of Hematology Oncology, University of Arizona Medical Center, Tucson, Arizona, USA
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Flaherty DC, Aguilar F, Pradhan B, Grewal H. Rapunzel syndrome due to ingested hair extensions: Surgical and psychiatric considerations. Int J Surg Case Rep 2015; 17:155-7. [PMID: 26629852 PMCID: PMC4701859 DOI: 10.1016/j.ijscr.2015.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/06/2015] [Accepted: 11/11/2015] [Indexed: 12/21/2022] Open
Abstract
Consuming hair extensions can lead to intestinal obstruction. Massive gastric trichobezoar extending into the duodenum is termed Rapunzel syndrome. Rapunzel syndrome often requires surgical intervention. 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.
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Affiliation(s)
- Devin C Flaherty
- Rowan University School of Osteopathic Medicine, Department of General Surgery, One Medical Center Drive, Stratford, NJ 08084, USA.
| | - Francis Aguilar
- Cooper University Hospital, Department of Psychiatry, Three Cooper Plaza, Suite 307, Camden, NJ 08103, USA
| | - Basant Pradhan
- Cooper University Hospital, Department of Psychiatry, Three Cooper Plaza, Suite 307, Camden, NJ 08103, USA
| | - Harsh Grewal
- Cooper University Hospital, Department of Pediatric Surgery, Three Cooper Plaza, Suite 403, Camden, NJ 08103, USA
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