A Rare Case of Rapunzel Syndrome - A Small Bowel Trichobezoar

Abstract

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.