Rapunzel syndrome:The unsuspected culprit

Trichobezoar is a rare intriguing disorder in which swallowed hairs accumulates in the stomach. Being indigestible and slippery, it could not be propulsed and becomes entrapped within the stomach. Large amounts can thus accumulate over the years forming a hair ball. Rapunzel syndrome is a variant where hair accumulation reaches the small gut and beyond in some cases. Although the syndrome has been known for many years, only 24 cases have been reported in the literature and the discovery of a new case is always surprising. In this report, we present two cases discovered within a period of three months. One of them was pregnant and had small bowel intussusception and perforation, a very rare combination. We hereby add two more cases to the literature. To our knowledge, this is the first report on two cases of Rapunzel syndrome, the diagnosis of which demands a high index of suspicion.

Mechanical upper bowel obstruction caused by a large trichobezoar in a young woman: A very unusual case report

BACKGROUND Bezoars usually compile human fibers and debris.A special form of bezoar in case of psychologically altered individuals is the trichobezoar.It consists of voluntarily swallowed hair bulks and is normally removed via gastroscopy.Trichobezoars leading to ileus have rarely been reported.CASE SUMMARY A 24-year-old female patient presented to the emergency room with abdominal pain,nausea,and vomiting for 3 d.Her previous medical and psychiatric history was unremarkable.Laboratory analysis showed iron deficiency anemia,leukocytosis,and elevated liver enzymes.An abdominal CT scan revealed a dense structure in the patients’stomach which turned out to be a huge trichobezoar completely obstructing the pylorus.The trichobezoar had to be removed surgi-cally.During her postoperative course,a subcutaneous seroma formed.After a single puncture,the rest of the recovery process was unremarkable,and the patient recovered fully.CONCLUSION A mechanical bowel obstruction is a potentially life-threatening event for every patient.In our case a young female was suffering from severe symptoms of an obstruction which might have resulted in serious harm without successful surgical management.

Gastric Trichobezoar, Case Presentations

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.