An Unusual Form of a Trichobezoar Causing a Peculiar Case of Appendicitis: A Case of Rapunzel Syndrome

Gabriel, Michael; Qureshi, Ehsaan; Miah, Mohammad; Husain, Najam

doi:10.7759/cureus.7554

Cited by 6 publications

(8 citation statements)

References 9 publications

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“…This pathology has several complications. The complicated forms are summed up in digestive hemorrhage due to ulcerations of the gastric wall, mechanical occlusion, digestive perforation witch can be responsible of peritonitis or sub-phrenic abscess or digestive fistula, acute pancreatitis, and appendicitis [10] , [11] ( Table 1 ).…”

Section: Clinical Discussionmentioning

confidence: 99%

Trichobezoar: A case report of a double gastric and ilial localization revealed by an occlusion

Khalifa

Ghannouchi

Nacef

et al. 2022

International Journal of Surgery Case Reports

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Introduction and importance A bezoar is an agglutination of ingested materials forming an indigestible and insoluble mass inside the gastrointestinal tract. Trichobezoars formed by ingested hair are rare. The stomach tends to be the typical location. In some cases there is an extension to the duodenum, jejunum or even to the colon and it is called Rapunzel syndrome. Case presentation We present a case of an occlusion due to double trichobezoars in 17 years old woman who underwent an extraction by enterotomy and gastrotomy. Clinical discussion Trichobezoar is a compact conglomeration of swallowed hair and makes up less than 6% of all bezoars. It appears in young women under 20 years of age who carry psychiatric or chronic metabolic diseases that can alter the behavioral balance. Physical examination is often poor in uncomplicated forms: forms without peritonitis or occlusion or hemorrhage or appendicitis or pancreatitis but it may reveal a well-limited, smooth, firm, and mobile epigastric mass. For uncomplicated forms or forms complicated by hemorrhage, the reference examination requested in the first line remains the esophagogastroduodenoscopy (EGD) which allows a dual role both diagnostic and therapeutic. Computed Tomography (CT) remains the preferred imaging modality requested urgently in case of an occlusion or peritonitis presentation. Endoscopic extraction represents the therapeutic approach for uncomplicated forms but surgical treatment remains the main therapeutic means of trichobezoar. Conclusion Trichobezoars are rare and present both diagnostic and therapeutic challenge. Laparotomy remains the most successful surgical treatment although laparoscopy currently appears to have promising results in expert hands. A post-operative pscychologic management is essential to correct psychobehavioral disorders of patients to prevent recurrence.

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Section: Clinical Discussionmentioning

confidence: 99%

Trichobezoar: A case report of a double gastric and ilial localization revealed by an occlusion

Khalifa

Ghannouchi

Nacef

et al. 2022

International Journal of Surgery Case Reports

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“…Success rate with a laparotomy and extraction is 99%; the mass can be removed in total making it the treatment of choice especially in RS. [7,12] In summary, though uncommon, Rapunzel syndrome should be kept in the differential diagnoses especially in a young female patient with and without any psychiatric illness who presents with features of an upper GI obstruction and a non-tender, palpable epigastric mass. Surgical removal is the gold standard and a long-term follow-up combined with a psychiatrist's support is recommended to prevent a recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…It can also present with complications such as gastric ulceration, intestinal obstruction/perforation, intussusception, cholestatic jaundice, and acute pancreatitis, etc. [5][6][7] The diagnostic tools are CT scan abdomen and upper GI endoscopy; the latter being the gold standard. Treatment options include endoscopy or surgery either laparoscopic or open laparotomy.…”

Section: Introductionmentioning

confidence: 99%

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Every tangle has a story - Rapunzel Syndrome: A case report

Khan¹,

Zaib

Tufail

et al. 2022

J Pediatr Adolesc Surg

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Background: Rapunzel syndrome is the rarest form of trichobezoar; a condition in which trichobezoar extends beyond the stomach into the small intestine. It is common among children and young girls with a history of psychiatric illnesses. Case Presentation: A 10-year-old girl without any history of psychiatric illness, presented with abdominal pain and non-bilious vomiting for 6 months. Clinically she had a non-tender upper abdominal mass which, later at workup, was found to be a trichobezoar. She was surgically managed successfully. Conclusion: Though uncommon, Rapunzel syndrome should be kept in the differential diagnoses especially in a young female patient with features of an upper GI obstruction and a non-tender, palpable epigastric mass.

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“…Even rarer still is appendicitis due to a trichobezoar with only seven reported cases [ 1–7 ]. In these cases, the hair is usually human resulting from psychological conditions with trichotillomania (compulsive hair pulling) and trichophagia (compulsive hair swallowing) [ 2 ]. We present an unusual case of acute appendicitis secondary to a trichobezoar of ingested feline hair.…”

Section: Introductionmentioning

confidence: 99%

Acute appendicitis with associated trichobezoar of feline hair

Redden

Ghadiri

2022

Journal of Surgical Case Reports

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A trichobezoar is an accumulation of ingested hair that forms a mass within the gastro-intestinal tract. Thrichobezoars usually consist of human hair and are known to cause obstruction and even perforation of gastrointestinal organs. There have been approximately seven reported cases of acute appendicitis with association trichobezoars found at the time of appendicectomy. We report a unique case of acute appendicitis with an associated trichobezoar of feline hair. A 15-year-old male presented with a 24-hour history of abdominal pain. A computed tomography scan demonstrated features of appendicitis with several hyperdensities within the base of the appendix. At the time of appendicectomy, the appendix was found to be perforated at the base. Faecoliths were identified containing numerous short, light-coloured hairs. Following the procedure, the family confirmed that they have a pet cat with short, light-coloured hair. The patient had an uneventful recovery.

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An Unusual Form of a Trichobezoar Causing a Peculiar Case of Appendicitis: A Case of Rapunzel Syndrome

Cited by 6 publications

References 9 publications

Trichobezoar: A case report of a double gastric and ilial localization revealed by an occlusion

Trichobezoar: A case report of a double gastric and ilial localization revealed by an occlusion

Every tangle has a story - Rapunzel Syndrome: A case report

Acute appendicitis with associated trichobezoar of feline hair

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