Rapunzel syndrome due to ingested hair extensions: Surgical and psychiatric considerations. (2015)

• Record Type: Journal Article
• Authors: Flaherty, Devin C.; Aguilar, Francis; Pradhan, Basant; Grewal, Harsh
• Is Part Of: International journal of surgery case reports. Volume 17(2015)
• Page Start: 155
• Page End: 157
• Publication Date: 2015
• Subjects: Trichotillomania -- Trichophagia -- Trichobezoar -- Obstruction -- Rapunzel syndrome; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2015.11.009
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Consuming hair extensions can lead to intestinal obstruction. Massive gastric trichobezoar extending into the duodenum is termed Rapunzel syndrome. Rapunzel syndrome often requires surgical intervention. Patients with Rapunzel syndrome require close psychiatric follow-up. Abstract: Introduction: Rapunzel syndrome is a unique clinical manifestation of trichotillomania and trichophagia. The resulting gastric trichobezoar can be massive and necessitate surgical extraction. Presentation of case: We present a case involving a 15 year-old female with a known history of trichotillomania. The patient possessed symptoms of nausea and early satiety, and admitted that she had recently consumed a large number of hair extensions. Computed tomography imaging revealed a massive gastric bezoar not amenable to endoscopic extraction. The patient underwent surgical laparotomy, and a large gastric trichobezoar was removed through an anterior gastrotomy. The trichobezoar extended past the pylorus into the duodenum, thus confirming a diagnosis of Rapunzel syndrome. Discussion: Trichobezoars formed from the consumption of hair extensions is a rare cause of Rapunzel syndrome. Surgical extraction is often necessitated due to the sheer size of the gastric bezoar that results from consuming hair extensions. If not previously established, psychiatric consultation should be pursued in the immediate post-operative course as these patients may require pharmacologic management along with behavioral therapy to avoid further episodes of trichotillomania. Conclusion: This case presents a unique and modern manifestation of Rapunzel syndrome. Surgical treatment most often is required when a patient presents with a massive gastric trichobezoar. Regular post-operative psychiatric follow-up is necessary to prevent recurrent episodes.