Rapunzel Syndrome Research Articles

A RARE CASE OF RAPUNZEL SYNDROME - A SMALL BOWEL TRICHOBEZOAR

Bezoars are concretions of foreign material in the gastrointestinal tract, mainly the stomach. In humans, the most common type of bezoar is the trichobezoar, is more often found in children and teenage girls. . The most frequent type of bezoar in adults is phytobezoar. A rare manifestation of trichobezoar is Rapunzel syndrome (RS) which occurs when the bezoar extends into the small intestine. An 11 years old girl from low socio economic social status presented to emergency department. . She had a complain of abdominal pain and vomiting before 3 month which was relieved itself after vomiting which contains hair, threads and cloths. Abdominal examination revealed a generalised abdominal distension. Ultrasonography (USG) of abdomen was done. . Trichobezoar was removed by open surgery with longitudinal enterotomy. The mass was occupying 30cm part of terminal ileum up to iliocecal junction with a putrid smell which was removed from enterotomy. Trichobezoars are a bizarre medical problem, and Rapunzel syndrome is an extremely uncommon variety of trichobezoar which occurs when the bezoar extends into the small intestine. The diagnosis of trichobezoar is possible on imaging in a proper clinical setting.
 Keywords: Trichobezoar, Rapunzel Syndrome, Enterotomy.

Rapunzel syndrome

Rapunzel syndrome

Unusual trichobezor of stomach and intestines as a manifestation of Rapunzel syndrome: a rare case report

Rapunzel syndrome is a rare form of trichobezoar with accumulation of large amounts of hair extending from stomach to variable portion of small intestine. An 18 year old girl was brought to surgery opd with complaints of vomiting on and off since 3 months. Contrast enhanced computed tomography abdomen showed a bezoar extending from stomach into the duodenum and proximal jejunum suggestive of Rapunzel syndrome with 3rd and 4th part of duodenum along with duodenojejunal junction. On laparotomy, a trichobezoar occupying the entire stomach measured 100 cm in length and 700 grams in weight. Since the mass formed in Rapunzel syndrome is generally too large to be removed endoscopically or laparoscopically, it requires removal by open gastrostomy.

Rapunzel syndrome with anal protrusion of trichobezoar

• Trichobezoars that pass through the intestinal lumen are classified as the Rapunzel syndrome. • Its symptoms are abdominal pain, náusea, vomits, and it can evolve to intestinal obstruction and peritonitis. • We report a case where a 6-year-old female patient presents a bezoar with exteriorization to the anal canal.

Rapunzel syndrome in a 7-year-old boy: A case report

Background: Trichobezoar is a condition in which hair mixed with food material is formed in stomach. Rapunzel’s syndrome is a rare variant of trichobezoar where the mass in stomach extends through pylorus into duodenum & varying length of small intestine & sometimes into colon. Case presentation: 7-year-old male patient presented in Surgery OPD with recurrent attacks of acute epigastric pain, vomiting and loss of appetite; was diagnosed with Rapunzel Syndrome, especially where the trichobezoar was not suspected at all because of the negative history of trichophagia. The purpose of reporting this case is the rare occurrence of such condition discussing the presentation, diagnostic modalities & the ideal option of surgical treatment.

Jejunal perforation secondary to trichobezoar (Rapunzel syndrome): a rare presentation

Trichobezoar is a rare disorder. It usually occurs in young and adolescent females associated with some psychiatric illness. Trichobezoar usually accumulate in the GI tract and most commonly in stomach but it can migrate through the pylorus into the jejunum, ileum and colon. Once the bezoars extends from the stomach into the jejunum or further on, it is referred to as “Rapunzel syndrome”. Though initially asymptomatic but over a period of time it may cause gastric mucosal erosion, ulceration, and perforation of the stomach or the small intestine. If unrecognized, tichobezoar may present with intussusceptions, obstructive jaundice, protein-losing enteropathy, pancreatitis and even death. Small trichobezoar may be extracted by endoscopic fragmentation but bezoars like Rapunzel Syndrome, on the other hand, need open surgical removal. Counseling by a psychiatrist is an important part of management to prevent recurrence.

A Rare Case of Isolated Trichobezoar in Jejunum Presenting as Obstruction - A Case Report

A trichobezoar is a mass formed by ingestion and accumulation of undigested hair inside the gastrointestinal tract. Stomach is the most common site which may extend to duodenum as well as jejunum, which is then referred as Rapunzel Syndrome. Incidence of trichobezoar in paediatric population is around 0.4% [1]. It is seen typically in girls usually with a history of trichotillomania and trichophagia. Affected children may remain unnoticed until it causes obstructive symptoms. We hereby report a unique case of isolated jejunal trichobezoar presenting as intestinal obstruction in an 8yr old girl.

Woman With Chronic Abdominal Pain, Weight Loss, and Palpable Abdominal Mass

Question: A 43-year-old woman with a past medical history of prior morbid obesity body mass index 53 (current body mass index 24), well-controlled type II diabetes on metformin presented with a 1-year history of early satiety, worsening reflux symptoms, abdominal pain, 163 lbs weight loss, and abdominal distension. She was evaluated by her primary physician 1 year prior for similar symptoms, was referred for gastroenterology evaluation but the patient never followed up with her appointments and was lost to follow-up. She presented to the emergency department with acute exacerbation of abdominal pain, nausea, nonbilious emesis, and progressive oral intolerance. Her vital signs were within normal limits; physical examination was remarkable for alopecia and temporal wasting, a palpable nontender tense epigastric and pelvic mass with associated left axillary and left inguinal adenopathies. Her laboratory workup was notable for microcytic hypochromic anemia, with anysocitosis, low iron levels with elevated haptoglobin; white blood cells, folate, and albumin were normal. The rest of the workup, including occult blood testing, was normal. An abdominal computed tomography scan demonstrated severe gastric distention with a large heterogeneous mass with a swirling appearance and multiple foci of gas measuring approximately 18 × 21 × 10 cm displacing the left kidney and an enlarged myomatous uterus containing a dominant partially calcified fibroid measuring up to 13 cm (Figure A, B). What is the diagnosis and approach to management of this patient? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. This patient presented with a rare case of Rapunzel syndrome. Upon further history, the patient reported trichotillomania and trichophagia since she was 5 years old. Computed tomography scan findings were consistent with a large heterogeneous mass within the stomach lumen consistent with bezoar. The size of the bezoar was not amenable to endoscopic extraction; therefore, the patient underwent a laparotomy with a midline 5-cm incision, an Alexis O Wound Protector (Applied Medical, Rancho Santa Margarita, CA) was used to prevent spillage of gastric contents and bezoar fragments into the abdominal cavity.1Obinwa O. et al.Rapunzel syndrome is not just a mere surgical problem: a case report and review of current management.World J Clin Cases. 2017’16; : 50-55Crossref PubMed Google Scholar, 2Fallon S.C. Slater B.J. Larimer E.L. et al.The surgical management of Rapunzel syndrome: a case series and literature review.J Pediatr Surg. 2013; 48: 830-834Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar, 3Hall J.D. Shami V.M. Rapunzel’s syndrome: gastric bezoars and endoscopic management.Gastrointest Endosc Clin N Am. 2006; 16: 111-119Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar A longitudinal anterior gastrotomy was performed and removal of the gastric trichobezoar was completed (Figure C and Supplemental Video). eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI3ODQ0ZGQ0YTBhYzMzMWI2YTJiMWI2ODE5YWEyOWYwMSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc4ODgyMTA4fQ.qT5Tmuw2vrDBVrGQDje4LUSu3V-Qw4Hs07X_13l4-sEV33Tmu4vbs0f326E53X_7d92aSrDZ7kvlknyR6k5Zsudig6mqF19lhqkydYI58nWtTrLfdqlNTlZrTFcuUvDou7D-mUQU3Cwlp7jnLPaGEm4GLupL_qcil91ftYtwsITw1EbZcDC2CUHSO7f86upSkH14FKj6P9oPlORIaxUftBvZovWMfayACLpWZguIbkBrZvIcSlLSnsqDu902liAA0lok10l_h4DSRNyHqz8vNxkVXMp9_r1Alkqdp4EjjC5CNrt5w2ZqeAm067J7maRqgEi55d3OTncC9D5TEZALpQ Download .mp4 (5.63 MB) Help with .mp4 files Video

A rare presentation of Rapunzel syndrome with multiple small bowel intussusceptions

A rare presentation of Rapunzel syndrome with multiple small bowel intussusceptions

Rapunzel Syndrome: a rare case of acute abdomen associated with gastric perforation

Rapunzel Syndrome: a rare case of acute abdomen associated with gastric perforation

Laparoscopic Management of Rapunzel Syndrome

Rapunzel syndrome is caused by ingestion of hairs, which leads to formation of trichobezoar, which can extend up to small intestine especially in girls. Utility of laparoscopic approach for this condition is not well established in this population. We are presenting a case of Rapunzel syndrome in a 14-year-old girl presenting as a cause of gastric outlet obstruction. Early diagnosis and extraction of trichobezoar by laparoscopic-assisted approach in children may be a better approach with respect to cosmesis, lesser morbidity, and early recovery.

Rapunzel syndrome; Report of two cases

Rapunzel syndrome is a rare form of trichobezoar, with less than 50 cases have been reported in literature so far, of which only four cases reported in male child. Bezoars are concretions in the gastrointestinal tract that increase in size by continuous accumulation of non-absorbable food or fibers. Patient commonly present with abdominal pain, vomiting and signs of obstruction. We are reporting a series of two cases (one boy and one girl child) of Rapunzel syndrome with one presented at age of five year. Keywords: Trichobezoar, Rapunzel syndrome, Broken family, Psychiatric pathology, Male child, Surgery.

Gastric ascariasis mimicking rapunzel syndrome in an epileptic patient: Learning points galore

Rapunzel syndrome refers to a very rare condition in which swallowed hair forms a gastric trichobezoar that has a long tail extending into the small bowel. It presents with early satiety, malnutrition, obstructive symptoms, and sometimes, gastric-outlet obstruction. Despite the varied manifestations of Ascaris infestation in man, gastric ascariasis is rare which is demonstrated in the stomach by radiology and by endoscopic examination. We present a rare case of trichobezoar in a 14 years epileptic female with recurrent seizure episodes and no prior history of psychiatric illness or worm infestation where the final diagnosis of gastric ascariasis was made on upper gastrointestinal-endoscopy revealing the presence of worms at the level of the fundus and body of the stomach. Endoscopically some worms were removed, and the rest passed down dead in stools after antihelminthic treatment. Recovery was uneventful and free of complications. Frequent seizures could also be attributed to malabsorption of anti-epileptic drugs because of gastric ascariasis. A prompt diagnosis (tissue diagnosis and direct visualization) always scores above characteristic radiologic findings and appropriate therapy can reduce comorbidities.

A Laparoscopically Operated Case of Rapunzel Syndrome Presented with Intussusception

A Laparoscopically Operated Case of Rapunzel Syndrome Presented with Intussusception

Síndrome de Rapunzel. Reporte de caso.

El síndrome de Rapunzel se caracteriza por un tricobezoar gástrico con extensión más allá del píloro. Se presenta el caso de una niña de 4 años 5 meses que, tras presentar cuadro de dolor abdominal crónico, distensión abdominal postprandial, hiporexia y pérdida de peso, al examen físico se palpó una masa sólida en epigastrio. La endoscopia digestiva alta confirmó tricobezoar en estómago. Se le realizó laparotomía exploradora y se extrajo tricobezoar gástrico que se extendía hasta la tercera porción de duodeno.

From trichotillomania to rapunzel syndrome- a case report

From trichotillomania to rapunzel syndrome- a case report

Rapunzel Syndrome and Small Bowel Intussusceptions Due to a Cotton Thread Bezoar: A Case Report

AbstractRapunzel syndrome is a rare disease in which a trichobezoar extends into the duodenum or distal small intestine. It is associated with compulsive eating of indigestible substances or pica and is more common in cases of underlying psychiatric disturbances. If left untreated, gastrointestinal bezoars with or without the Rapunzel syndrome may lead to several complications such as ulceration, perforation, peritonitis, pancreatitis, biliary obstruction, severe nutritional disturbances, and rarely intestinal obstruction. We present an exceptionally rare case of Rapunzel syndrome caused by a large cotton thread bezoar in an adolescent girl, associated with multiple jejunal intussusceptions. Further, we present a literature review of this entity. An interesting association of bezoar with intussusception is explained. Since a history of pica may not be forthcoming in all cases, it is important to be familiar with the imaging characteristics, complications, and management of bezoars.

Surgical outcome of jejunum-jejunum intussusception secondary to Rapunzel syndrome: a case report

BackgroundAdult intestinal intussusception is a rare condition caused by the mechanical disruption of bowel motility. A bezoar is defined as indigestible material inside the gastrointestinal tract that develops into a trapped mass; the most frequent bezoar is a trichobezoar. When a trichobezoar extends into the small intestine it is defined as Rapunzel’s syndrome. Literature describing complications related to this pathology remains scarce.Case presentationA 16-year-old Mexican girl presented to our emergency room with acute abdomen and a presumptive diagnosis of intestinal obstruction. Computed tomography was suggestive of intussusception. Surgery confirmed a jejunal-jejunal intussusception with a mass within the gastric cavity extending into her small intestine, corresponding to a trichobezoar. A manual intussusception reduction and a gastrotomy with extraction of the trichobezoar were performed.ConclusionsWe present a case of a jejunum intussusception as a complication of Rapunzel syndrome. Our patient had a favorable outcome after surgical intervention with a manual intussusception reduction, with retrograde displacement of the trichobezoar into the gastric lumen, and a complete extraction through a gastrostomy. Follow-up included psychiatric evaluation.

Rapunzel syndrome: a review of unusual case

A rare condition characterized by trichophagia, or the swallowing of one’s own own hair, leading to a solid mass that forms in the gastrointestinal tract. The resulting blockage of the gastrointestinal tract may be fatal. The hair forms a solid mass in the digestive tract known as a trichobezoar. It causes abdominal pain and nausea, but can also present as an asymptomatic abdominal mass, progressing to abdominal obstruction and perforation. It is predominantly found in emotionally disturbed or mentally retarded youngsters. We present the youngest case of Rapunzel syndrome in the Surat Municipal Institute of Medical Education and Research Hospital, Surat, India, a 7-year-old girl who present with abdominal pain and non-tender abdominal mass.

Management of Rapunzel Syndrome in a Four-month Pregnant Female with Twins: The First Reported Case?

A bezoar is a collection of packed indigestible matter that accumulates in the gastrointestinal tract after ingestion by the patient. It may be made of hair (trichobezoar), vegetable or fruit (phytobezoar), or other indigestible materials. Trichobezoars are thought to form due to hair’s natural enduring nature, as they get matted and stick together in the gut. We present the case of a young female who was 16-weeks pregnant with twins presenting to the general surgery clinic with abdominal pain, vomiting and a palpable abdominal mass, which eventually turned out to be a massive trichobezoar manifesting as Rapunzel syndrome. Rapunzel syndrome is a large trichobezoar extending from the stomach into the small intestine. This is perhaps the first reported case of Rapunzel syndrome in a patient pregnant with twins.