Rapunzel syndrome: a rare presentation with giant gastric ulcer.

Antonios Athanasiou,Nikolaos Dimitrokallis,Demetrios Moris,John Griniatsos,Demetrios Oikonomou,Adamantios Michalinos,Evangelos Felekouras,Eleftherios Spartalis,Vaios Kaminiotis

doi:10.1155/2014/267319

Antonios Athanasiou, Nikolaos Dimitrokallis + Show 7 more

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https://doi.org/10.1155/2014/267319

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Abstract

The Rapunzel syndrome refers to an uncommon and rare form of trichobezoar that extends past the stomach into the small intestines. The Rapunzel syndrome is usually found in young female patients with a history of psychiatric disorders, mainly trichotillomania and trichophagia. We describe a case of Rapunzel syndrome in a 15-year-old girl who presented with abdominal pain, vomiting, and weight loss. We performed a surgical laparotomy and successfully removed a huge trichobezoar extending into the small intestine.

Highlights

A bezoar is a mass of foreign and intrinsic material found in the gastrointestinal tract, most commonly in the stomach
Despite the fact that incidence of trichobezoar is reported to be very low (0.4%) [7], the actual rate is unknown due to the fact that this syndrome is generally seen in people with psychiatric disorders
While there are studies supporting that there is no development of trichobezoars in a number of patients with trichotillomania [5], a number of other studies report this rate as high as 25% [8]

Summary

Introduction

A bezoar is a mass of foreign and intrinsic material found in the gastrointestinal tract, most commonly in the stomach. Bezoars can be classified in six types: phytobezoars (composed of indigestible plant material), trichobezoars (hairball or hair-like fibers), lithobezoars (fragments of small stones, pebbles, or gravel stones), pharmacobezoar (mostly tablets or semiliquid masses of drugs), plasticobezoars (plastic), and lactobezoars (inspissated milk) [2]. In contrast to most types of bezoars, trichobezoars are usually observed in individuals linked to pica and other psychiatric conditions, such as emotional disturbance, learning disabilities, and history of neglect or mental retardation. These individuals pull out their own hair and swallow it, processes referred to as trichotillomania and trichophagia [4, 5]. We present a rare case of RS in a 15-year-old girl, who presented with epigastric pain and malabsorption-related complications

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