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 report...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.展开更多
Bezoars are usually confined to the stomach which is seen in individuals with psychiatric illness like trichotillomania,trichophagia and gastric dysmotility.Long standing bezoars may extend into the small intestine le...Bezoars are usually confined to the stomach which is seen in individuals with psychiatric illness like trichotillomania,trichophagia and gastric dysmotility.Long standing bezoars may extend into the small intestine leading to a condition known as Rapunzel syndrome.Diagnosis can be established by endoscopy,ultrasonography and computed tomography scan.Treatment includes improvement of general condition and removal of bezoar by laparoscopic approach or laparotomy.Psychiatric consultation is necessary to treat and prevent relapse.We report a case of Rapunzel syndrome in a 16-yearold girl with trichotillomania.She presented with history of epigastric mass for three months and recent onset of pain abdomen,vomiting and early satiety.Skiagram of abdomen was showing distended stomach and endoscopy revealed trichobezoar.At laparotomy,stomach was distended with trichobezoar and there were multiple small intestinal intussusceptions.Gastrotomy and manual reduction of intussusceptions with the removal of trichobezoar with its tail was done.Patient recovered completely after the procedure.展开更多
Recurrent Rapunzel syndrome(RRS) is a rare clinical presentation with fewer than six cases reported in the Pub Med literature. A report of RRS and literature review is presented. A 25-year-old female was admitted to h...Recurrent Rapunzel syndrome(RRS) is a rare clinical presentation with fewer than six cases reported in the Pub Med 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.展开更多
Trichobezoars are accumulations of hair casts in the stomach which is associated with trichophagia. The continuous ingestion causes mass of undigested material within the gastrointestinal, accumulating between the muc...Trichobezoars are accumulations of hair casts in the stomach which is associated with trichophagia. The continuous ingestion causes mass of undigested material within the gastrointestinal, accumulating between the mucosal folds of stomach. Trichotillomania, is a mental disorder, described when someone cannot resist the urge to pull their hair from the scalp, eyebrows or eyelashes seen generally by teenagers or adolescents. A person with trichotillomania may experience repetitive pulling of hair, often without awareness, associated with anxiety and a sense of relief after pulling out hair. Consumed hair strands are beyond the pylorus into the small bowel identified as Rapunzel syndrome. Two cases of trichobezoars were encountered in our centre. They presented with nonspecific abdominal pain and abdominal mass. After investigations, with clinical correlation they were subjected to surgery, an open gastrotomy and complete removal of the trichobezoars. After surgery, the aim is to prevent recurrence by tackling the underlying cause of trichophagia which is commonly associated with trichotillomania. This case report series discusses about the management of trichobezoars.展开更多
文摘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.
文摘Bezoars are usually confined to the stomach which is seen in individuals with psychiatric illness like trichotillomania,trichophagia and gastric dysmotility.Long standing bezoars may extend into the small intestine leading to a condition known as Rapunzel syndrome.Diagnosis can be established by endoscopy,ultrasonography and computed tomography scan.Treatment includes improvement of general condition and removal of bezoar by laparoscopic approach or laparotomy.Psychiatric consultation is necessary to treat and prevent relapse.We report a case of Rapunzel syndrome in a 16-yearold girl with trichotillomania.She presented with history of epigastric mass for three months and recent onset of pain abdomen,vomiting and early satiety.Skiagram of abdomen was showing distended stomach and endoscopy revealed trichobezoar.At laparotomy,stomach was distended with trichobezoar and there were multiple small intestinal intussusceptions.Gastrotomy and manual reduction of intussusceptions with the removal of trichobezoar with its tail was done.Patient recovered completely after the procedure.
文摘Recurrent Rapunzel syndrome(RRS) is a rare clinical presentation with fewer than six cases reported in the Pub Med 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.
文摘Trichobezoars are accumulations of hair casts in the stomach which is associated with trichophagia. The continuous ingestion causes mass of undigested material within the gastrointestinal, accumulating between the mucosal folds of stomach. Trichotillomania, is a mental disorder, described when someone cannot resist the urge to pull their hair from the scalp, eyebrows or eyelashes seen generally by teenagers or adolescents. A person with trichotillomania may experience repetitive pulling of hair, often without awareness, associated with anxiety and a sense of relief after pulling out hair. Consumed hair strands are beyond the pylorus into the small bowel identified as Rapunzel syndrome. Two cases of trichobezoars were encountered in our centre. They presented with nonspecific abdominal pain and abdominal mass. After investigations, with clinical correlation they were subjected to surgery, an open gastrotomy and complete removal of the trichobezoars. After surgery, the aim is to prevent recurrence by tackling the underlying cause of trichophagia which is commonly associated with trichotillomania. This case report series discusses about the management of trichobezoars.
