Rapunzel syndrome is not just a mere surgical problem: A case report and review of current management

Abstract

Recurrent Rapunzel syndrome (RRS) is a rare clinical presentation with fewer than six cases reported in the PubMed literature. A report of RRS and literature review is presented. A 25-year-old female was admitted to hospital with a 4-wk history of epigastric pain and swelling. She had a known history of trichophagia with a previous admission for Rapunzel syndrome requiring a laparotomy nine years earlier, aged 16. Psychological treatment had been successfully achieved for nine years with outpatient hypnotherapy sessions only, but she defaulted on her last session due to stressors at home. The abdominal examination demonstrated an epigastric mass. Computer tomography scan revealed a large gastric bezoar and features of aspiration pneumonia. The patient underwent emergency open surgical laparotomy for removal as the bezoar could not be removed endoscopically. The bezoar was cast in a shape that mimicked the contours of the stomach and proximal small bowel, hence the diagnosis of RRS. The patient was seen by a psychiatrist and was commenced on Quetiapine before discharge. She continues to attend follow-up.

Trichobezoar as a cause of pediatric acute small bowel obstruction

“…A critical aspect of management which cannot be overlooked is secondary prevention. Recurrent trichobezoar has been reported and usually occurs in patients who have not had adequate psychiatric evaluation or follow‐up . Due to the rarity of this condition, there are no consensus guidelines on the long‐term management of TTM or for patients after trichobezoar extraction.…”

“…Recurrent trichobezoar has been reported and usually occurs in patients who have not had adequate psychiatric evaluation or follow-up. 20 Due to the rarity of this condition, there are no consensus guidelines on the long-term management of TTM or for patients after trichobezoar extraction. No benefit has been demonstrated for the use of psychotherapy, fluoxetine, or clomipramine in the treatment of TTM although cognitive-behavioral therapy (CBT) was associated with significant improvements over both clomipramine and placebo.…”

Rapunzel syndrome causing partial gastric outlet obstruction requiring emergency laparotomy

“…Relapse of the condition is possible with case reports showing a 2-year to 9-year interval period in cases of recurrent Rapunzel syndrome 10…”

Revisión sistemática del Síndrome de Rapunzel

“…El síndrome de Rapunzel es un tricobezoar que se extiende desde el estómago hasta el intestino delgado, y muy a menudo se observa en mujeres jóvenes con trastornos mentales como la tricotilomanía y que puede acompañarse de tricofagia (8). La tricotilomanía se define como el deseo irresistible que uno tiene de arrancarse el cabello y se encuentra incluido en el manual de diagnóstico estadístico (DSM-5) de la Asociación Americana de Psiquiatría desde el año 2013, como un trastorno obsesivo compulsivo (9). La tricofagia es el acto de comerse el cabello (10).…”