PDF herunterladen
CC BY 4.0 · Surg J (N Y) 2022; 08(04): e293-e296
DOI: 10.1055/s-0042-1757777
Case Report

Rapunzel Syndrome: A Case of Trichobezoar with Small Bowel Complications

Ramakrishna Narra
1   Department of Radio-diagnosis, Katuri Medical College, Guntur, Andhra Pradesh, India
,
Anusha Guntamukkala
1   Department of Radio-diagnosis, Katuri Medical College, Guntur, Andhra Pradesh, India
,
Chanda Bhaskara Rao
2   Department of Pediatric Surgery, Guntur Medical College, Guntur, Andhra Pradesh, India
,
Tanveer Begum
3   Department of Pediatrics, Katuri Medical College, Guntur, Andhra Pradesh, India
› Institutsangaben Funding None.
› Weitere Informationen
   Lizenzen und Reprints

Abstract

Introduction Rapunzel syndrome is characterized by a large trichobezoar in the stomach with a tail extending beyond the pylorus into the small bowel, causing mechanical obstruction of the small bowel. A 7-year-old girl presented to the emergency room with severe epigastric pain. Computed tomography suggested trichobezoar causing jejuno-jejunal intussusceptions, bowel wall thickening, and dilated small bowel loops proximal to the obstruction. On laparotomy, two concealed perforations were noted at the duodenojejunal (DJ) junction and 40 cm distal to the DJ junction. An enterotomy incision was given at the antimesenteric border of the distal jejunal perforation site, and the mass was successfully extracted. Primary repair was done at the DJ perforation site, and resection was followed by an end-to-end anastomosis at the distal jejunal perforation site. Surgery confirmed a complex mass of tangled hair within the gastric cavity with a tail extending into the pylorus of the stomach and small intestine, consistent with trichobezoar.

Conclusion Computed tomography is superior to other radiological imaging modalities for diagnosing trichobezoars as it helps diagnose and demonstrate mechanical bowel complications.

Keywords

trichobezoar - Rapunzel syndrome - intussusceptions - contrast-enhanced computed tomography


Publikationsverlauf

Eingereicht: 29. Juni 2022

Angenommen: 12. September 2022

Artikel online veröffentlicht:
06. November 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Kim SC, Kim SH, Kim SJ. Case Rep Med 2016; 95 (22) e3745
    PubMed
  • 2 Prasanna BK, Sasikumar K, Gurunandan U, Sreenath GS, Kate V. Rapunzel syndrome: a rare presentation with multiple small intestinal intussusceptions. World J Gastrointest Surg 2013; 5 (10) 282-284
    CrossrefPubMedGoogle Scholar
  • 3 Frey AS, McKee M, King RA, Martin A. Hair apparent: Rapunzel syndrome. Am J Psychiatry 2005; 162 (02) 242-248
    CrossrefPubMedGoogle Scholar
  • 4 Anantha RV, Chadi SA, Merritt N. . Trichobezoar causing intussusception: Youngest case of Rapunzel syndrome in a boy in North America, Journal of Pediatric Surgery Case Reports, Volume 1, Issue 1, 2013, Pages e11-e13, ISSN 2213–5766
    PubMed
  • 5 Diggikar PM, Satpathy PK, Kakrani AL. et al. An adolescent girl with Rapunzel syndrome: case report with review of literature. Med J DY Patil Univ 2013; 6: 200-204
    CrossrefPubMedGoogle Scholar
  • 6 Ishaq N, Khaleeq T. Rapunzel syndrome – a case report: trichobezoar as a cause of gastric outlet obstruction and intestinal perforation. Dubai Med J 2022; 5: 122-124
    CrossrefPubMedGoogle Scholar
  • 7 García-Ramírez BE, Nuño-Guzmán CM, Zaragoza-Carrillo RE, Salado-Rentería H, Gómez-Abarca A, Corona JL. Small-bowel obstruction secondary to ileal trichobezoar in a patient with Rapunzel syndrome. Case Rep Gastroenterol 2018; 12 (03) 559-565
    CrossrefPubMedGoogle Scholar
  • 8 Dogra S, Kulkarni AK, Rao PP. Rapunzel syndrome-a case report. Med J Armed Forces India 2012; 68 (03) 249-251
    CrossrefPubMedGoogle Scholar
  • 9 Naik S, Gupta V, Naik S. et al. Rapunzel syndrome reviewed and redefined. Dig Surg 2007; 24 (03) 157-161
    CrossrefPubMedGoogle Scholar
  • 10 Raghu V, Nagadi A, Kumar A. Rapunzel syndrome and small bowel intussusceptions due to a cotton thread Bezoar: a case report. J Gastrointest Abdominal Radiol 2018; 1 (01) 56-59
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 11 Nour I, Abd Alatef M, Megahed A, Yahia S, Wahba Y, Shabaan AE. Rapunzel syndrome (gastric trichobezoar), a rare presentation with generalised oedema: case report and review of the literature. Paediatr Int Child Health 2019; 39 (01) 76-78
    CrossrefPubMedGoogle Scholar
  • 12 Hamidi H, Muhammadi M, Saberi B, Sarwari MA. A rare clinic entity: huge trichobezoar. Int J Surg Case Rep 2016; 28: 127-130
    CrossrefPubMedGoogle Scholar
  • 13 Maglinte DD, Heitkamp DE, Howard TJ, Kelvin FM, Lappas JC. Current concepts in imaging of small bowel obstruction. Radiol Clin North Am 2003; 41 (02) 263-283 , vi
    CrossrefPubMedGoogle Scholar
  • 14 Ripollés T, García-Aguayo J, Martínez MJ, Gil P. Gastrointestinal bezoars: sonographic and CT characteristics. AJR Am J Roentgenol 2001; 177 (01) 65-69
    CrossrefPubMedGoogle Scholar
  • 15 Gorter RR, Kneepkens CM, Mattens EC, Aronson DC, Heij HA. Management of trichobezoar: case report and literature review. Pediatr Surg Int 2010; 26 (05) 457-463
    CrossrefPubMedGoogle Scholar