Extremely unusual case of gastrointestinal trichobezoar

Abstract

Trichobezoars (hair ball) are usually located in the stomach, but may extend through the pylorus into the duodenum and small bowel (Rapunzel syndrome). Rapunzel syndrome remains uncommon; with fewer than 40 cases reported. To the best of our knowledge, this case may be the first well-documented case with a length of 75 cm. They are almost always associated with trichotillomania and trichophagia or other psychiatric disorders. In the literature several treatment options are proposed, including removal by conventional laparotomy, laparoscopy and endoscopy. Herein, we are reporting an interesting case of an 18-year mentally retarded girl with history of trichotillomania and trichophagia who presented to our emergency department with a history of central abdominal pain associated with vomiting and constipation for five days. An examination showed a trichobezoar requiring emergent surgical intervention, and indicating the need for psychiatric treatment. The trichobezoar was treated successfully by laparoscopy.

"Rapunzel Syndrome: An Unusual Onset Case Report"

“…Laparotomy is still the treatment of choice for large trichobezoars because of its advantages which include the simplicity of the procedure, less time required and feasibility to examination all the bowel for satellite lesions [18]. However, laparoscopic intervention seems to be gaining ground over open surgical operation and there are several cases reporting the laparoscopic removal of extremely long and large trichobezoars [19]. Recurrence has been reported owing to improperly treated psychiatric conditions and missed follow-up [20].…”

Rapunzel syndrome: a rare form of trichobezoar in the stomach with some extension into the small intestine

“…Laparoscopic removal of a trichobezoar could be a surgical option; however, it may be hard to achieve when trichobezoars are large. In addition, there is a lack of surgical experience with this technique because of the rarity of trichobezoars, especially the entity of Rapunzel syndrome (6,12). Postoperatively, the girl made an uneventful recovery.…”

Rapunzel syndrome due to ingested hair extensions: Surgical and psychiatric considerations

“…All patients reported were female, and all required surgical laparotomy to accomplish extraction of the trichobezoar [9] . While laparotomy has traditionally been the accepted method of extraction due to the sheer size of these bezoars, laparoscopic techniques have been recently described in the literature [10] . Complications such as obstruction, perforation, intussusception, or giant gastric ulceration may arise if Rapunzel syndrome is left untreated [11] , [12] , [13] .…”