Rapunzel syndrome in adult with mysterious presentation: a rare case report with literature review. (April 2019)

• Record Type: Journal Article
• Authors: Kumar, Navin; Huda, Farhanul; Gupta, Rohit; Payal, YS; Kumar, Utkarsh; Mallik, Dhiraj
• Is Part Of: Tropical doctor. Volume 49:Number 2(2019)
• Page Start: 133
• Page End: 135
• Publication Date: 2019-04
• Subjects: Trichobezoars -- Rapunzel syndrome; Tropical medicine -- Periodicals; Medical care -- Developing countries -- Periodicals; Developing Countries -- Periodicals; Tropical Medicine -- Periodicals; Tropische geneeskunde; 616.9883
• DOI: 10.1177/0049475519826477
• Languages: English
• ISSNs: 0049-4755

Abstract

Bezoars are indigestible foreign material in the gastrointestinal tract (GIT). A phytobezoar is a mass of plant material, while a trichobezoar consists of matted hair. This is found most commonly in the stomach in children who chew their long hair. When a gastric trichobezoar extends to the duodenum or jejunum, this is known as Rapunzel syndrome (RS), after a famous Brothers' Grimm fairy tale. Our patient presented with haematemesis, localised peritonitis, a palpable epigastric mass, coagulopathy, severe anaemia and deranged liver function tests. An abdominal computed tomography scan was suggestive of a bezoar; gastroduodenoscopy confirmed the diagnosis. Treatment of trichobezoars normally involve endoscopic removal or gastrotomy and psychiatric intervention. They may also cause haematemesis, gastric outlet obstruction, gastric ulceration and perforation, multiple jejuno-jejunal intussusception, acute pancreatitis and cholestatic jaundice. Trichobezoar was first reported in the 18th century by Baudamant in a 16-year-old boy. RS was first described in 1968.