L e t t e r t o t h e E d i t o rDear Sir, A gastric trichobezoar is an accumulation of hair, usually the patient's own, in the stomach. It can become very large, often presenting with a 'tail' extending into the duodenum; in this form, it is called the Rapunzel syndrome.(1) Gastric trichobezoars most commonly occur in teenage girls with a concomitant, frequently undiagnosed psychiatric disorder known as trichotillomania. Only one-third of these patients have trichophagia and just 1% ingest enough hair to require surgical intervention.(1) Presentation is usually delayed, often occurring after the ingestion of large amounts of hair over many years.We herein report a case of a 13-year-old girl who presented with gastric outlet obstruction and symptomatic anaemia. Abdominal examination revealed a vague epigastric mass. On upper endoscopy, a large trichobezoar was identified to be extending beyond the stomach, into the duodenum. Endoscopic removal was attempted but failed. The patient underwent exploratory laparotomy with gastrotomy, which revealed a trichobezoar extending from the greater curvature of the stomach beyond the pylorus, into the duodenum, with a third bezoar concretion 120 cm from the ileocecal valve. The gastroduodenal and intestinal bezoars were successfully removed via anterior gastrotomy and enterotomy, respectively. A string was seen embedded in the trichobezoar. It snapped during removal of the gastroduodenal bezoars ( Fig.
Rotational atherectomy or rotablation is commonly used in lesion preparation for calcified coronary artery. However, rotablation is relatively contraindicated in cases with high thrombus load lesion, such as acute ST-elevation myocardial infarction (STEMI). We are presenting a case of acute STEMI treated with rotablation. Rotablation was used to facilitate the primary percutaneous coronary intervention (PCI) with calcified coronary artery, after unsuccessful attempt with scoring balloon dilation. Although there was slow flow due to high thrombus load in STEMI, we learnt that with meticulous rotablation techniques, the procedure could be done safely. The final result was excellent and patient was discharged well after 3 days.
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