scholarly journals Rapunzel syndrome causing partial gastric outlet obstruction requiring emergency laparotomy

2020 ◽  
Vol 13 (1) ◽  
pp. e232904
Author(s):  
Robert Lyons ◽  
Granit Ismaili ◽  
Michael Devine ◽  
Haroon Malik
Keyword(s):  
Ct Scan ◽  
Gastric Outlet Obstruction ◽  
Epigastric Pain ◽  
Outlet Obstruction ◽  
Postoperative Recovery ◽  
Emergency Laparotomy ◽  
Rapunzel Syndrome ◽  
History Of

A 16-year-old girl with a background of childhood trichophagia presented with a 2-day history of epigastric pain and associated anorexia with vomiting. An epigastric mass was palpable on examination. A CT scan revealed an intragastric trichobezoar, extending into the duodenum consistent with Rapunzel syndrome with evidence of partial gastric outlet obstruction and a possible perforation. The patient underwent an urgent laparotomy and extraction of the trichobezoar. The bezoar was removed without complication and no intraoperative evidence of perforation was detected. After an uncomplicated postoperative recovery, she was discharged home with psychiatric follow-up.

scholarly journals Unusual Tissue – Unusual Issue: Pancreatic Heterotopia Presenting as Gastric Outlet Obstruction

2021 ◽  
pp. 338-343
Author(s):  
Thu L. Nguyen ◽  
Shivani Kapur ◽  
Stephen C. Schlack-Haerer ◽  
Grzegorz T. Gurda ◽  
Milan E. Folkers
Keyword(s):  
Gastric Outlet Obstruction ◽  
Epigastric Pain ◽  
Outlet Obstruction ◽  
Needle Aspiration ◽  
Pancreatic Tissue ◽  
Cystic Mass ◽  
Pancreatic Heterotopia ◽  
History Of

Pancreatic heterotopia (PH) is a common, but typically small (<1 cm), incidental and asymptomatic finding; however, PH should be considered even for large and symptomatic upper gastrointestinal masses. A 27-year-old white woman presented with a 3-week history of burning epigastric pain, nausea, early satiety, and constipation. Physical examination revealed epigastric and right upper quadrant tenderness with normal laboratory workup, but imaging revealed a 5-cm, partly cystic mass arising from the gastric antrum with resulting pyloric stenosis and partial gastric outlet obstruction. Endoscopic ultrasound-guided fine needle aspiration revealed PH – an anomalous pancreatic tissue lying in a nonphysiological site. The patient ultimately underwent a resection and recovered uneventfully, with a complete pathologic examination revealing normal exocrine pancreatic tissue (PH type 2) without malignant transformation. We report a case of heterotopic pancreas manifesting as severe gastric outlet obstruction, in addition to a thorough diagnostic workup and surgical follow-up, in a young adult. Differential diagnoses and features that speak to benignity of a large, symptomatic mass lesion (PH in particular) are discussed.

scholarly journals Incarcerated Lumbar Hernia Complicated by Retroperitoneal Pseudoaneurysm 50 Years after Resection and Radiation Therapy of a Sarcoma

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Oluwatobi Onafowokan ◽  
Dabanjan Bandyopadhyay ◽  
Dale Johnson ◽  
Hugo J. R. Bonatti
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Ct Scan ◽  
Late Complication ◽  
Abdominal Hernia ◽  
Emergency Laparotomy ◽  
Incisional Hernias ◽  
History Of ◽  
The Right

Background. Lumbar hernias are rare abdominal hernias. Surgery is the only treatment option but remains challenging. Posterior incisional hernias are even rarer especially with incarceration of intra-abdominal contents.Case Presentation. A 68-year old female presented with a 3-day history of worsening acute abdominal pain and distension, with multiple episodes of emesis. A CT scan indicated a large incarcerated posterolateral abdominal hernia. The patient had a history of resection of a sarcoma on her back as a child and also received chemotherapy and radiation. During emergency laparoscopy, a hemorrhagic small bowel segment incarcerated in the hernia was reduced and resected, and the distended small bowel was decompressed. An elective hernia repair was scheduled. After temporary clinical improvement, the patient again developed abdominal pain, distention, and emesis. During emergency laparotomy, a large hematoma in the right flank was found and partially evacuated. The right colon was mobilized out of the hernia and the duodenum was kocherized. A20×20cm BIO-A mesh was placed on top of the Gerota fascia and cranially tucked under liver segment VI. Anteriorly, the mesh was fixated with absorbable tacks. The duodenum and colon were placed into the mesh pocket. A postoperative CT scan identified a 2 cm pseudoaneurysm of a side branch of a lumbar artery, and the bleeding source was embolized. The postoperative course was complicated byClostridium difficile-associated colitis, but ultimately, the patient recovered fully. At 6-month follow-up, there was no evidence for a recurrent hernia.Discussion. There is a paucity of literature concerning lumbar incisional hernias. Repair with bioabsorbable mesh seems feasible, but longer follow-up is necessary as the mesh was placed in an unusual fashion due to the retroperitoneal hematoma. The exact cause of the hemorrhage is unclear and may have been caused during the initial incarceration, during surgery, or may be a late complication of her previous radiation.

scholarly journals Rapunzel syndrome resulting in gastric perforation

2016 ◽  
Vol 98 (1) ◽  
pp. e6-e7 ◽  
Author(s):  
JS Parakh ◽  
A McAvoy ◽  
DJ Corless
Keyword(s):  
Gastric Perforation ◽  
Postoperative Recovery ◽  
Patch Repair ◽  
Free Fluid ◽  
Proximal Jejunum ◽  
Rapunzel Syndrome ◽  
Omental Patch ◽  
History Of ◽  
Entire Stomach

We report the case of an 18-year-old female patient with no past medical history who presented to the emergency department with acute abdominal pain and vomiting on the background of a long history of ingesting hair (trichophagia). Computed tomography revealed pneumoperitoneum and free fluid in keeping with visceral perforation. In addition, a large hair bolus was seen extending in contiguity from the stomach to the jejunum. A laparotomy was performed, revealing an anterior gastric perforation secondary to a 120cm long trichobezoar, which had formed a cast of the entire stomach, duodenum and proximal jejunum. The bezoar was removed and an omental patch repair to the anterior ulcer was performed. The patient made an excellent postoperative recovery and was discharged home with psychiatric follow-up review.

scholarly journals Bouveret’s syndrome: A challenging case of gastric outlet obstruction.

2020 ◽  
Vol 27 (06) ◽  
pp. 1316-1319
Author(s):  
Marrium Gul ◽  
Irfan Qadir ◽  
Muhammad Qasim Butt
Keyword(s):  
Gastric Outlet Obstruction ◽  
Epigastric Pain ◽  
Duodenal Bulb ◽  
Outlet Obstruction ◽  
Postoperative Recovery ◽  
Blood Analysis ◽  
Bouveret’S Syndrome ◽  
Endoscopic Extraction ◽  
Bilioenteric Fistula ◽  
Bouveret's Syndrome

Bouveret’s syndrome causes gastric outlet obstruction when a gallstone is impacted in the duodenum or stomach via a bilioenteric fistula. We present case of a 40-year-old female presented with epigastric pain and intractable vomiting for 2 days. Her physical examination and laboratory workup including blood analysis, amylase test and lipase test were normal. Plain abdominal X-ray did not show any signs of small bowel obstruction. A nasogastric tube was placed and drained 2.5 L of gastric contents immediately. Esophagogastroduodenoscopy showed a dilated stomach with excessive secretions and a large blackish-brown hard stone in the duodenal bulb. After failed attempt at endoscopic extraction, patient underwent laparotomy and removal of stone via duodenal incision. Subsequently, the patient exhibited a good postoperative recovery. The condition of the patient has remained stable after being followed up for one year.

scholarly journals Medication Bezoar Causing acute Gastric Outlet Obstruction: A Case Report

2016 ◽  
Vol 33 (3) ◽  
pp. 177-180 ◽  
Author(s):  
Md Abdul Mazid
Keyword(s):  
Gastric Outlet Obstruction ◽  
Epigastric Pain ◽  
Outlet Obstruction ◽  
Uneventful Recovery ◽  
Upper Gastrointestinal Endoscopy ◽  
Abdominal Ultrasonography ◽  
Life Threatening ◽  
History Of ◽  
Upper Gastrointestinal ◽  
Made In

Medication bezoars are rare and are composed of medications and/or medication vehicles. Rarely, medication bezoars can cause serious problems due to complications such as perforation, obstruction, haemorrhage. A 60 years old woman presented with 10 days history of epigastric pain, weakness and postprandial non-bilious vomiting. Her abdominal ultrasonography showed strong post acoustic shadow noted within 1st part of duodenum possibly foreign body. Upper gastrointestinal endoscopy was performed and a bezoar of tablet of aluminum hydroxide was extracted. The patient had uneventful recovery. Acute gastric outlet obstruction is relatively uncommon and mostly due to foreign bodies related to food impaction, with meat being the most frequent culprit. The diagnostic approach to acute gastric outlet obstruction is similar to other cause of GOO. However, therapeutic options differ for each patient. The diagnosis should be made in prompt time to prevent life threatening complications due obstruction and/or effect of medication forming bezoar.J Bangladesh Coll Phys Surg 2015; 33(3): 177-180

scholarly journals Successful Emergency Endoscopic Treatment of Gastric Outlet Obstruction due to Gastric Bezoar with Gastric Pneumatosis

2017 ◽  
Vol 11 (3) ◽  
pp. 718-723 ◽  
Author(s):  
Hirokazu Honda ◽  
Takashi Ikeya ◽  
Erika Kashiwagi ◽  
Shuichi Okada ◽  
Katsuyuki Fukuda
Keyword(s):  
Gastric Outlet Obstruction ◽  
Endoscopic Treatment ◽  
Fluid Collection ◽  
Outlet Obstruction ◽  
Serum Lactate ◽  
Rebound Tenderness ◽  
Gastric Bezoar ◽  
History Of ◽  
Upper Abdominal

Gastric bezoars are rare and are usually found incidentally. They can sometimes cause severe complications, including gastric outlet obstruction (GOO) or gastric pneumatosis (GP). In cases of bezoars with GP, the optimal treatment strategy has not yet been defined. We report the case of an 89-year-old man with a history of type 2 diabetes mellitus and hypertension who presented to our emergency room with a 2-day history of upper abdominal pain, nausea, and vomiting. Physical examination revealed no rebound tenderness or guarding, and laboratory values revealed no elevation of the serum lactate level. A computed tomography scan of the abdomen showed a dilated stomach with significant fluid collection, GOO, and GP due to a 42 × 40 mm mass composed of fat and air densities. Emergency esophagogastroduodenoscopy revealed two gastric bezoars, one of which was incarcerated in the pyloric region. We used various endoscopic devices to successfully break and remove the bezoars. We used endoscopic forceps and a water jet followed by an endoscopic snare to cut the bezoars into several pieces and remove them with an endoscopic net. Follow-up endoscopy confirmed that the gastric bezoar had been completely removed. As seen in this case, endoscopic treatment may be a safe and viable option for the extraction of gastric bezoars presenting with GOO and GP.

scholarly journals Gastric trichobezoar and Rapunzel syndrome: a case report

2020 ◽  
Vol 7 (5) ◽  
pp. 1634
Author(s):  
Abhishek Gupta ◽  
Panna Lal Gupta
Keyword(s):  
Case Report ◽  
Epigastric Pain ◽  
Exploratory Laparotomy ◽  
Adolescent Females ◽  
Young Adolescent ◽  
Adolescent Female ◽  
Rapunzel Syndrome ◽  
Gastric Trichobezoar ◽  
History Of

Giant gastric trichobezoars are unusual form of foreign body found in stomach of mostly young adolescent females which may lead to morbidity and high mortality 30%, if goes unnoticed. These females have history of trichophagia or trichotillomania. This report is of a 12- year old young adolescent female presented with epigastric pain and mass. An exploratory laparotomy with anterior gastrotomy was performed and a giant trichobezoar with a very large tail of 2.5 ft was removed, weighing 2.52 kg. She recovered well and was discharged on 7th post-operative day. Patient was advised for psychiatric follow up.

scholarly journals Rapunzel Syndrome – A Case Report: Trichobezoar as a Cause of Gastric Outlet Obstruction and Intestinal Perforation

2021 ◽  
pp. 1-3
Author(s):  
Nazia Ishaq ◽  
Tahir Khaleeq
Keyword(s):  
Case Report ◽  
Gastric Outlet Obstruction ◽  
Intestinal Perforation ◽  
Unusual Case ◽  
Outlet Obstruction ◽  
Adolescent Females ◽  
Rapunzel Syndrome ◽  
Gastric Trichobezoar ◽  
Rare Manifestation

Rapunzel syndrome is described as a rare manifestation of gastric trichobezoar extending throughout the bowel and is associated with psychiatric disorders. Its incidence in Pakistan is very rare and is found characteristically in adolescent females. Large or complicated trichobezoars are best managed by surgery. Psychiatric follow-up is essential to diminish the frequency of recurrence. We report an unusual case of Rapunzel syndrome causing gastric outlet obstruction and intestinal perforation.

scholarly journals Reversed Bowel Rotation with Midgut Volvulus and Internal Hernia

2020 ◽  
pp. 1-5
Author(s):  
Mona Mogahed ◽  
Atif Mahmoud Mahdi ◽  
Hasn Hifni ◽  
Hassan Juma ◽  
Mona Mogahed ◽  
...  
Keyword(s):  
Ct Scan ◽  
Internal Hernia ◽  
Postoperative Recovery ◽  
Emergency Laparotomy ◽  
Midgut Volvulus ◽  
Ladd Procedure ◽  
Uneventful Postoperative Recovery ◽  
Reversed Rotation ◽  
Operative Findings

Congenital intestinal malrotation is a group of intestinal rotational anomalies occurring during embryogenesis. Reversed rotation is considered the rarest type of malrotation and often presents with symptoms of bowel obstruction. We present a rare case of a 27-year-old woman who presented with acute abdomen. The patient’s preoperative computed tomography (CT) scan and operative findings confirmed reverse malrotation, internal hernia of foramen of Winslow, and midgut volvulus. The transverse colon, duodenum, small bowel, cecum, and appendix were abnormally located, with the presence of Ladd bands. The patient underwent an emergency laparotomy (Ladd procedure) with an uneventful postoperative recovery and an unremarkable follow-up CT scan of the abdomen. A review of the literature for intestinal reverse malrotation is also presented to provide an understanding of the expected clinical picture and imaging findings for this rare anomaly.

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