Trichobezoar Intestinal Obstruction: Rapunzel Syndrome

Bezoars are conglomerations of undigested foreign material retained in the gastrointestinal tract. Trichobezoar is a compact conglomeration of swallowed hair and constitutes less than 6% of all bezoars. Their most frequent location is in the stomach but they may extend through the pylorus into the small bowel. This condition is known as Rapunzel syndrome. Many patients may remain asymptomatic or present a mild form of the disease characterized by abdominal pain, early satiety, nausea, and vomiting. Complications may manifest as gastric outlet obstruction or bleeding, and intestinal obstruction. A 15-year-old female patient presented with clinical findings of intestinal obstruction. The patient suffered from depressive and anxiety disorders and trichotillomania, although trichophagy could not be assured. Alopecia circumscripta and irregular hair length on the scalp were identified. A computed tomography (CT) scan showed two images highly suggestive of trichobezoars, one in the stomach and the second one causing obstruction at the ileocecal valve. At laparotomy, both a mobile gastric trichobezoar with a tail extending to the duodenum and a trichobezoar causing obstruction at the ileocecal valve were removed. The postoperative course was uneventful. The passage of a detached trichobezoar fragment in a patient with Rapunzel syndrome may cause intestinal obstruction. CT is the preferred image modality for the evaluation of suspected trichobezoars in order to characterize their size and locations, the presence and level of obstruction, and complications such as ischemia or perforation. A case of small-bowel obstruction secondary to ileal trichobezoar in a patient with Rapunzel syndrome is herein reported.

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Rapunzel syndrome presenting as acute pancreatitis, hypoproteinaemia and subsequent distal intestinal obstruction

Journal of Pediatric Surgery Case Reports ◽

10.1016/j.epsc.2020.101507 ◽

2020 ◽

Vol 59 ◽

pp. 101507 ◽

Cited By ~ 1

Author(s):

Kavinda Dayasiri ◽

Astor Rodrigues ◽

Alex Lee

Keyword(s):

Acute Pancreatitis ◽

Intestinal Obstruction ◽

Rapunzel Syndrome ◽

Distal Intestinal Obstruction

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Trichobezoars: a hairy cause of intestinal obstruction

International Surgery Journal ◽

10.18203/2349-2902.isj20201900 ◽

2020 ◽

Vol 7 (5) ◽

pp. 1658

Author(s):

Anurag Tiwary ◽

Pragati Singhal ◽

Nida Khan ◽

Pramod Tiwary

Keyword(s):

Small Bowel ◽

Intestinal Obstruction ◽

Acute Intestinal Obstruction ◽

Age Group ◽

Rapunzel Syndrome ◽

Surgical Exploration ◽

Paediatric Age

Trichobezoars are an infrequent form of bezoar found in the stomach or intestine, created from ingested hair. Their most frequent location is in the stomach but they may extend through the pylorus into the small bowel. This condition is known as Rapunzel syndrome. Trichobezoar with Rapunzel syndrome is an uncommon diagnosis in children. Authors report 3 cases of Rapunzel syndrome with a large bezoar in paediatric age group that presented with features of acute intestinal obstruction. They were managed with surgical exploration.

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Trichobezoar: presenting as primary Intestinal obstruction

The Journal of Medical Sciences ◽

10.5005/jp-journals-10045-0002 ◽

2015 ◽

Vol 1 (1) ◽

pp. 4-6

Author(s):

KC Madhushankar ◽

K Manjunath ◽

B Saiprasad ◽

M Saishayam

Keyword(s):

Small Bowel ◽

Intestinal Obstruction ◽

Abdominal Mass ◽

Gastrointestinal Symptoms ◽

Laparoscopic Approach ◽

Abdominal Distension ◽

Rapunzel Syndrome ◽

Rare Type ◽

Pain Abdomen ◽

History Of

ABSTRACT Rapunzel syndrome is a rare type of trichobezoar with an extension of the hair into the small bowel. Clinical presentation is deceptive and vague ranging from abdominal mass to gastrointestinal symptoms. Bezoars are usually confined to the stomach which is seen in individuals with psychiatric illness, like trichotillomania, trichophagia and gastric dysmotility. Long standing bezoars may extend into the small intestine leading to a condition known as Rapunzel syndrome. Trichobezoars presenting primarily as intestinal obstruction is very rare. Diagnosis can be established by endoscopy, ultrasonography and computed tomography scan. Treatment includes improvement of general condition and removal of bezoar by laparoscopic approach or laparotomy. Psychiatric consultation is necessary to treat and prevent relapse. We present the case of a 6 years old girl, where the trichobezoar was not suspected at all, especially with negative history of trichophagia and trichotillomania. This girl presented with history of intermittent pain abdomen since 3 months and recent onset severe pain abdomen with abdominal distension and vomiting. Skiagram of abdomen revealed dilated small bowel loops with multiple air fluid levels suggestive of intestinal obstruction. Even ultrasonogram of abdomen was also inconclusive for cause of obstruction. At laparotomy, dilated small bowel loops with multiple interbowel adhesions were seen. A hard mass measuring 5 × 6 cm was seen at distal jejunum causing distal obstruction with pressure necrosis over bowel wall. Enterotomy was done which revealed trichobezoar which was removed en masse. Resection and anastomosis of necrosed jejunum was done. Patient recovered completely after the procedure. How to cite this article Madhushankar KC, Manjunath K, Saiprasad B, Saishayam M. Trichobezoar: Presenting as Primary Intestinal Obstruction. J Med Sci 2015;1(1):4-6.

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A RARE PRESENTATION OF RAPUNZEL SYNDROME WITHOUT INTESTINAL OBSTRUCTION WITH REVIEW OF LITERATURE

Indian Journal of Case Reports ◽

10.32677/ijcr.2020.v06.i07.002 ◽

2020 ◽

Vol 6 (7) ◽

pp. 355-357

Author(s):

Neha Garg ◽

Surender Verma ◽

Pradeep Garg ◽

Anil Mehta ◽

Vijay Pal ◽

...

Keyword(s):

Intestinal Obstruction ◽

Review Of Literature ◽

Rare Presentation ◽

Rapunzel Syndrome

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The Effect of Vomiting Due to Intestinal Obstruction on the Serum Potassium

Gastroenterology ◽

10.1016/s0016-5085(49)80005-9 ◽

1949 ◽

Vol 12 (1) ◽

pp. 49-56 ◽

Cited By ~ 13

Author(s):

Samuel Bellet ◽

Carl S. Nadler ◽

Peter C. Gazes ◽

Mary Lannzng

Keyword(s):

Intestinal Obstruction ◽

Serum Potassium

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Two Siblings with Total Colonic Aganglionosis Extended to the Ileum

Swiss Surgery ◽

10.1024/1023-9332.9.4.187 ◽

2003 ◽

Vol 9 (4) ◽

pp. 187-189

Author(s):

Aslan ◽

Caglar ◽

Karagüzel ◽

Melikoglu

Keyword(s):

Intestinal Obstruction ◽

Loop Ileostomy ◽

Good Condition ◽

Disease Type ◽

Definitive Treatment ◽

Entire Colon ◽

Total Colonic Aganglionosis ◽

Protective Ileostomy ◽

Definitive Surgery ◽

Partial Intestinal Obstruction

Total colonic aganglionosis (TCA) extended to the ileum is seen quite rare among infants with Hirschsprung's disease. Type and timing of definitive surgery in these patients are controversial. This report was presented to discuss the management of two siblings with TCA. Case 1: A two-day-old girl was operated for partial intestinal obstruction. During laparotomy, serial frozen biopsies proved TCA extended to the terminal ileum and a loop ileostomy was performed. At five months of age, a modified Duhamel-Martin procedure without protective ileostomy was performed. An endo-GIA stapler was transanally used for colo-ileal anastomosis. She is doing well for the last five years. Case 2: A one-day-old boy admitted to the hospital with similar findings to his sister. Frozen biopsies during first laparotomy proved that majority of ileum and entire colon was aganglionic and a proximal ileostomy was performed. At 10 months of age, he underwent a similar Duhamel-Martin operation. He is in a good condition for the last four years. Conclusion: In infants, our modification on Duhamel-Martin procedure, which is based on the use of an endo-GIA stapler transanally for colo-ileal anastomosis without protective ileostomy, may be utilized as an alternative method in the definitive treatment of patients with TCA.

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