Abstract
Rapunzel syndrome, defined by the presence of a trichobezoar extending from the stomach to the small intestine, is a rare cause of intestinal obstruction. It usually presents with vague symptoms; however, it can also present with complications such as perforation, peritonitis and obstructive jaundice. We report a rare case of a 37-year-old woman with Rapunzel syndrome complicated by acute cholangitis and pancreatitis and analyse the diagnosis and management of this complicated pathology. Although she reported a history of trichotillomania and trichophagia, she had been asymptomatic for ten years. We review the steps of diagnosis, highlighting the importance of a thorough clinical history and detailed examination, with supporting evidence from the contrast-enhanced computed tomography (CECT) scan. She was successfully managed with gastrotomy and trichobezoar removal. She had an uneventful postoperative recovery and was discharged after psychiatric counselling. To our knowledge, this is the first case of Rapunzel syndrome in a young female presenting with both cholangitis and pancreatitis.
Highlights
Rapunzel syndrome, defined by the presence of a trichobezoar extending from the stomach to the small intestine, is a rare cause of intestinal obstruction
We present a case of Rapunzel syndrome with both pancreatitis and cholangitis, seen in a young female
The case reveals that Rapunzel syndrome can have varied, often non-specific presentations as well as a myriad of complications such as cholangitis and pancreatitis, and it must be high on the differential diagnosis for patients with a psychiatric history
Summary
Abstract: Rapunzel syndrome, defined by the presence of a trichobezoar extending from the stomach to the small intestine, is a rare cause of intestinal obstruction. We report a rare case of a 37-year-old woman with Rapunzel syndrome complicated by acute cholangitis and pancreatitis and analyse the diagnosis and management of this complicated pathology. We review the steps of diagnosis, highlighting the importance of a thorough clinical history and detailed examination, with supporting evidence from the contrast-enhanced computed tomography (CECT) scan She was successfully managed with gastrotomy and trichobezoar removal. The most common type of bezoar seen mostly in females in the paediatric age group is a trichobezoar, which is a concretion of hair from external sources that amalgamate over the years. It is usually associated with psychiatric conditions such as trichotillomania, trichophagia and pica [2]. To the best of our knowledge, this is the first case of Rapunzel syndrome with both complications of cholangitis and pancreatitis
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