Rapunzel syndrome - a case report

• Authors: Miroslava Stojanovic , Andjelka Slavkovic , Zoran Marjanovic , Miroslav Stojanovic , Dragoljub Zivanovic
• Languages of publication: EN

Abstracts

EN

Bezoars are collections of indigestible materials found in the gastrointestinal tract. Rapunzel syndrome is a rare complication of a gastric trichobezoar in which the mass of hair extends through the pylorus into the small bowel and can even reach the colon. A 12-year-old girl with severe pain and a feeling of “fullness” in the upper abdomen was admitted to Pediatric Surgery. Two days before admission, the patient presented with vague abdominal pain, vomiting with a little blood, and black stool. On physical examination she was pale and listless with patchy alopecia. Abdominal examination showed a mobile, palpable mass in the epigastrium. The initial hematocrit was 7,1%, and the erythrocyte count was 1,12×1012 cells per liter. Abdominal ultrasound and computed tomographic (CT) examinations confirmed the presence of a tumor-like formation in stomach. A giant bezoar with ulceration on the back wall of the stomach was verified by upper gastrointestinal endoscopy. Endoscopic extraction was not possible because of the size of the bezoar. Gastrotomy was performed to remove the bezoar that occupied most of the stomach, with a long tail that extended deeply into the duodenum (Rapunzel syndrome). The bezoar, 35 by 10 cm in diameter, was black and consisted of hair and synthetic fibers. Prompt diagnosis and treatment of trichobezoars are important to avoid a possible fatal outcome.

Keywords

EN

Trichobezoar; Rapunzel syndrome; Laparotomy

• Publisher: De Gruyter Open
• Journal: Open Medicine
• Year: 2010
• Volume: 5
• Issue: 3
• Pages: 354-357

Dates

published

1 - 6 - 2010

online

9 - 4 - 2010

Contributors

author

Miroslava Stojanovic

• Clinic of pediatric surgery, Clinical centre Nis, Bulevar dr Zoran Djindjic 48, 18000, Nis, Serbia

author

Andjelka Slavkovic

• Clinic of pediatric surgery, Clinical centre Nis, Bulevar dr Zoran Djindjic 48, 18000, Nis, Serbia

author

Zoran Marjanovic

• Clinic of pediatric surgery, Clinical centre Nis, Bulevar dr Zoran Djindjic 48, 18000, Nis, Serbia

author

Miroslav Stojanovic

• Clinic of pediatric surgery, Clinical centre Nis, Bulevar dr Zoran Djindjic 48, 18000, Nis, Serbia

author

Dragoljub Zivanovic

• Clinic of pediatric surgery, Clinical centre Nis, Bulevar dr Zoran Djindjic 48, 18000, Nis, Serbia

References

• [1] Western C., Bokhari S., Gould S., Rapunzel Syndrome: A Case Report and Review, J. Gastrointest. Surg., 2008, 12, 1612–1614 http://dx.doi.org/10.1007/s11605-007-0408-4[Crossref]
• [2] Emre A.U., Tascilar O., Karadeniz G., Irkorucu O., Karakaya K., Comert M., Rapunzel syndrome of a cotton bezoar in a multimorbid patient, Clinics 2008, 63(2), 285–288 http://dx.doi.org/10.1590/S1807-59322008000200021[Crossref]
• [3] Rishi M., Elhousieni M., Mishra A., Ehtuish E.H., Hanesh A., Trichobezoar, Saudi. Med. J. 2006. 27(7), 1057–1059
• [4] Al Wadan A.H., Al Kaff H., Al Senabani J., Al Saadi A.S., ’Rapunzel syndrome’ trichobezoar in a 7-year-old girl: a case report, Cases J., 2008, 1, 205 http://dx.doi.org/10.1186/1757-1626-1-205
• [5] Naik S., Gupta V., Naik S., Rangole A., Chaudhary A.K., Jain P. et al., Rapunzel Syndrome Reviewed and Redefined, Dig. Surg., 2007, 24, 157–161 http://dx.doi.org/10.1159/000102098[Crossref]
• [6] Nair M.S., Nair B.M., A rare presentation of Rapunzel syndrome manifesting in the immediate post-appendicectomy period, The Internet Journal of Surgery, 2008, volume 14, number 2, http://www.ispub.com/journal/the_internet_journal_of_surgery/volume_14_number_2/article/a_rare_presentation_of_rapunzel_syndrome_manifesting_in_the_immediate_post_appendicectomy_period.html
• [7] Hirugade S.T., Talpallikar M.C., Deshpande A.V., Gavali S., Borwankar S.S., Rapunzel syndrome with a Long Tail, Indian J. Pediatr., 2001, 68(9), 895–896 http://dx.doi.org/10.1007/BF02762123[Crossref]
• [8] Chana R.S., Viral A., Kumar R., Gastrointestinal Bezoars in Children with Special Reference to Recurrent Trichobezoar, J. Indian Assoc. Pediatr. Surg., 2004, 9(1), 25–29
• [9] Rabie M.E., Arishi A.R., Khan A., Ageely H., El-Nasr G.A.S., Fagihi M., Rapunzel syndrome: The unsuspected culprit, World J. Gastroenterol., 2008, 14(7), 1141–1143 http://dx.doi.org/10.3748/wjg.14.1141[Crossref]
• [10] Klipfel A.A., Kessler E., Schein M., Rapunzel syndrome causing gastric emphysema and small bowel obstruction, Surgery, 2003, 133, 120–121 http://dx.doi.org/10.1067/msy.2003.41[Crossref]
• [11] Pace A.M., Fearne C., Trichobezoar in a 13 year old Male: A Case Report and Review of Literature, Malta Medical Journal, 2003, 15(1), 39–40
• [12] Phillips M.R., Zaheer S., Drugas G.T., Gastric Trichobezoar: Case Raport and Literature Review, Mayo Clin. Proc., 1998, 73, 653–656 http://dx.doi.org/10.4065/73.7.653[Crossref]
• [13] Duncan N.D., Aitken R., Venugopal S., West W., Carpenter R., The Rapunzel syndrome. Report of a case and review of the literature, West Indian Med. J., 1994, 43(2), 63–5

Identifiers

DOI

10.2478/s11536-009-0122-6