Abstract
Rapunzel syndrome is an extremely rare complication of a gastric trichobezoar in. We report here the unusual case of a case of a 16 years old girl presented with severe abdominal pain and vomiting. Clinical examination revealed a malnourished girl, with presence of a mobile and sensitive abdominal mass of 20x15 cm witch filled the upper quadrant. An abdominal computed tomography scan showed a heterogeneous mass occupying the whole stomach cavity with extension into the third portion of the duodenum. A diagnostic of giant trichobezoar is suspected after further questioning reveling a trichotillomania, trichophagia and onychophagia. The removal of the trichobezoar endoscopically failed and it was possible to pull only few fibers of hair to comfort the diagnostic. She was subjected to an exploratory laparotomy. An antral gastrostomy were performed and a 25x10x7 cm trichobezoar was extracted. The patient had an uneventful postoperative outcome and was derived to psychiatry. Rapunzel syndrome is an uncommon trichobezoar, it’s commonly found in young females usually with an underlying psychiatric disorder. Management requires gastrotomy. A psychiatric assessment and a long-term follow-up are advocated as a regular part of treatment to prevent recurrence.
Highlights
A trichobezoar is an agglomeration of hair which accumulate and remain within the gastrointestinal tract
Trichobezoars often coexist with learning disabilities or psychiatric illness [1], in Rapunzel syndrome, the foreign material extends through the pylorus into the small intestine
We report here the unusual case of a 16 years old girl presented with giant trichobezoar revealed by severe abdominal pain malnutrition
Summary
A trichobezoar is an agglomeration of hair which accumulate and remain within the gastrointestinal tract. Trichobezoars often coexist with learning disabilities or psychiatric illness [1], in Rapunzel syndrome, the foreign material extends through the pylorus into the small intestine. A 16-year-old female was referred to our surgical clinic with abdominal pain and vomiting of one year duration. Her personal history revealed trichophagia and onychophagia. There was a long tail of hair extending through the pylorus into the proximal jejunum, the spacemen takes the shape of the stomach and duodenum (Figure 4). By this feature the diagnosis was clear of a Rapunzel syndrome.
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