Trichobezoar - Rapunzel syndrome

Case contributed by Dr Maryam Shekarforoush

Presentation

Abdominal pain, indigestion and a palpable mass in the right iliac fossa

Patient Data

Age: 20 years
Gender: Female

Trichobezoar

MRI

Long segment filling defect in the distal ileum measuring 30cm in length, resulting in proximal small bowel obstruction with a diameter of 6.2cm. Some intervening small bowel loops are collapsed. The large bowel is not distended.

The lesion demonstrates T2 hypointensity and mainly T1 hypointensity. The minimal T1 hyperintensity is unchanged on T1 fat saturated images.  No restricted diffusion. This represents MRI characteristics of hair bezoar.

Pictures from gastroscopy

Photo

Trichobezoar within the stomach.

Resection specimen

Photo

The surgical specimen.

Case Discussion

Findings in keeping with trichobezoar AKA Rapunzel syndrome. .

Post MRI, a distant history of trichophagia as a teenager was elucidated by the radiologist.

Gastroscopy demonstrated a large trichobezoar within the stomach, unable to be retrieved. 

Subsequent laparotomy with successful removal of the gastric and distal ileum trichobezoars. 

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