Successful laparoscopic extraction of trichobezoar due to Rapunzel syndrome: first reported case in Kuwait

Abstract

Rapunzel syndrome is a rare condition typically found in young female patients with mental or psychiatric disorders. It manifests as a large trichobezoar extending beyond the pylorus into the small intestine and leads to various adverse conditions. Early diagnosis and prompt management are crucial to avoiding complications. These bezoars are extracted endoscopically, laparoscopically and via open surgery (most common). In this current report, we discuss a successful laparoscopic extraction of a trichobezoar in a 12-year-old girl with acute abdominal pain due to small-bowel obstruction. We describe our technique compared with others’ techniques and include a literature review on this topic.

Gastric Trichobezoar Causing Gastrointestinal Bleeding: A Case Report

“…Currently, minimally invasive procedures such as endoscopic fragmentation and removal or laparoscopic extraction of trichobezoar are the preferred choices for treatment [5][6][7]. However, the literature provides no evidence of the superiority of these techniques over open surgery.…”

“…Upper gastrointestinal endoscopy is the modality of choice to confirm the diagnosis. It can also be used for therapeutic purposes in early cases to avoid complications [ 6 ].…”

“…Surgical extraction can be performed by open or laparoscopic approach. The laparoscopic approach has the advantages of faster recovery, small incisions, and better cosmesis [ 6 , 8 , 9 ]. However, laparoscopic surgery may not be suitable in all cases.…”

Huge gastric trichobezoar caused by involuntary nocturnal trichophagia and trichotillomania in a female adolescent

“…The relevance of this entity is that it affects the process of nutrition and digestion, and depending on the size and distension of the digestive tract structures, it can cause perforation, infections (mainly mycosis and parasitosis), cholangitis and obstructive jaundice, intussusception and pancreatitis [5] , [6] . Therefore, it is a pathological entity that can seriously compromise the integrity, quality of life, functional capacity and life of the affected person [7] , [8] . At present, there is no specific solid evidence to manage this condition, so it is solved depending on the experience and tools of the surgical team [8] .…”

“…Therefore, it is a pathological entity that can seriously compromise the integrity, quality of life, functional capacity and life of the affected person [7] , [8] . At present, there is no specific solid evidence to manage this condition, so it is solved depending on the experience and tools of the surgical team [8] . However, another point to highlight is the fact that in the absence of psychiatric history and lack of information, the surgical diagnosis can identify psychological or psychiatric factors not previously investigated, which can definitively solve the primary cause, preventing the recurrence of trichobezoar in the future.…”