Rapunzel syndrome (trichobezoar)
Young female, taking anti-depressants, school drop-out, complaining of vague abdominal pain for past six months, history of non bilious vomiting after meals.
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There is a large heterogenous intraluminal mass with mottled gas pattern in the stomach, extending through the pylorus up to the second part of duodenum. There are similar appearing in the jejunum at the left hypochondrium and left flank region. Jenjunal mucosa is edematous at the level of trichobezoar. This was identified as trichobezoar and was removed via laparotomy, confirming the findings.
Trichobezoar is an intraluminal mass seen in gastrointestinal tracts containing ingested hair. Human hair, especially long female hair, is resistant to digestion as well as peristalsis. So it tends to stay in the stomach and over a period of time form a larger ‘hair ball’. The trichobezoar may extend up to the pylorus, duodenum or even jejunum. A part may break off into the small bowel and cause small bowel obstruction.
If not identified in time, the trichobezoar can cause gastric or duodenal mucosal erosion, ulceration, obstruction and sometimes small bowel perforation.
The treatment usually involves endoscopic removal of the trichobezoar. Rarely, laparoscopy or laparotomy may be needed.
- 1. Ripollés T, García-Aguayo J, Martínez MJ et-al. Gastrointestinal bezoars: sonographic and CT characteristics. AJR Am J Roentgenol. 2001;177 (1): 65-9. doi:10.2214/ajr.177.1.1770065 - Pubmed citation
- 2. Gorter RR, Kneepkens CM, Mattens EC et-al. Management of trichobezoar: case report and literature review. Pediatr. Surg. Int. 2010;26 (5): 457-63. doi:10.1007/s00383-010-2570-0 - Free text at pubmed - Pubmed citation