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Liang Y, Huang L, Wang D, Liu T, Li X, Wang W, Shen Q, Han J, Li S, Wang L, Chen L. Rapunzel syndrome in children: a retrospective review of ten cases combined with literature review in a tertiary referral center. Pediatr Surg Int 2024; 40:121. [PMID: 38703237 DOI: 10.1007/s00383-024-05705-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE Rapunzel syndrome is an uncommon condition in children, and its clinical features remain unclear. This study presents the largest single-center series of pediatric cases to date, with the objective of documenting the clinical characteristics and treatment approaches for children with Rapunzel syndrome. METHODS A retrospective study was conducted in children with Rapunzel syndrome from 2019 to 2023. We recorded age, gender, symptoms, locations of bezoar, complications, and treatment options. RESULTS Ten patients with Rapunzel syndrome were included. The median age was 9.1 years, with all of whom were female. The most common clinical symptoms were upper abdominal mass (90%), abdominal pain (80%), and nausea and vomiting (50%). Complications occurred in six cases (60%), including small bowel obstruction (20%), severe gastric dilatation (10%), intestinal perforation (10%), choledochodilation (10%), acute pancreatitis with cholecystitis (10%). Preoperative ultrasonography suggested low-echoic foreign bodies continuing to the jejunum or ileocecal region in five cases (50%). Preoperative gastroscopy attempted in four cases (40%) to remove the foreign bodies, all of which failed. All patients underwent surgical treatment, with nine cases undergoing gastric incision foreign body removal, and one case undergoing gastric incision foreign body removal combined with intestinal perforation repair. All patients recovered well. No recurrence was observed during follow-up. CONCLUSION The accuracy of ultrasound diagnosis in identifying Rapunzel syndrome is high; however, it may lead to misdiagnosis if not complemented with the patient's medical history. Endoscopic presents a heightened treatment risk and a reduced success rate. The condition commonly presents with severe complications, thus making laparotomy a safe and effective option for intervention.
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Affiliation(s)
- Yiyuan Liang
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Liuming Huang
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China.
| | - Dayong Wang
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Tingting Liu
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xianling Li
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Qiulong Shen
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jinbao Han
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Shuanling Li
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Li Wang
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Long Chen
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
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Kumar M, Maletha M, Bhuddi S, Kumari R. Rapunzel Syndrome in a 3-Year-Old Boy: A Menace too Early to Present. J Indian Assoc Pediatr Surg 2020; 25:112-114. [PMID: 32139992 PMCID: PMC7020672 DOI: 10.4103/jiaps.jiaps_1_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/22/2019] [Accepted: 04/20/2019] [Indexed: 01/01/2023] Open
Abstract
Rapunzel syndrome is a rare type of trichobezoar with an extension of the hair into the small bowel. Clinical presentation is deceptive and vague, ranging from asymptomatic abdominal mass to gastrointestinal perforation. There are only few cases reported in literature, with the youngest age being 3 years. We present the case of a 3-year-old male child presenting with Rapunzel syndrome and features of subacute intestinal obstruction.
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Affiliation(s)
- Mritunjay Kumar
- Department of Pediatrics and Neonatology, Apollomedics Super Speciality Hospital, Lucknow, Uttar Pradesh, India
| | - Madhukar Maletha
- Department of Pediatric Surgery, SGRR Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Sakshi Bhuddi
- Department of Pediatrics, SGRR Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Rashmi Kumari
- Department of Community Medicine, Dr. RML Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Nour I, Abd Alatef M, Megahed A, Yahia S, Wahba Y, Shabaan AE. Rapunzel syndrome (gastric trichobezoar), a rare presentation with generalised oedema: case report and review of the literature. Paediatr Int Child Health 2019; 39:76-78. [PMID: 29057712 DOI: 10.1080/20469047.2017.1389809] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Rapunzel syndrome is a rare form of gastric trichobezoar. A 4-year-old girl presented with generalised oedema and an epigastric mass. Her family was of a relatively low socio-economic background. There was microcytic hypochromic anaemia, hypoalbuminaemia and an elevated α1-antitrypsin clearance. Abdominal ultrasound and non-contrast computed tomography demonstrated a heterogeneous mass related to the stomach. Upper gastro-intestinal tract endoscopy failed to remove it. Surgical laparotomy was undertaken through a single anterior gastrotomy incision and a large mass was extracted which was a cast of the duodenum and stomach and had a tail of approximately 60 cm in length which extended to the jejunum. Low socio-economic status, child neglect and pica are risk factors for trichobezoars. Surgical laparotomy is the optimal treatment of large bezoars.
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Affiliation(s)
- Islam Nour
- a Department of Paediatrics, Faculty of Medicine , Mansoura University , Mansoura , Egypt
| | - Mona Abd Alatef
- a Department of Paediatrics, Faculty of Medicine , Mansoura University , Mansoura , Egypt
| | - Ahmed Megahed
- a Department of Paediatrics, Faculty of Medicine , Mansoura University , Mansoura , Egypt
| | - Sohier Yahia
- a Department of Paediatrics, Faculty of Medicine , Mansoura University , Mansoura , Egypt
| | - Yahya Wahba
- a Department of Paediatrics, Faculty of Medicine , Mansoura University , Mansoura , Egypt
| | - Abd Elazeez Shabaan
- a Department of Paediatrics, Faculty of Medicine , Mansoura University , Mansoura , Egypt
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Piotto L, Gent R. The value of ultrasound in the investigation of ingested foreign bodies in children. SONOGRAPHY 2018. [DOI: 10.1002/sono.12139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Lino Piotto
- Division of Medical Imaging; Women's and Children's Hospital; South Australia Australia
| | - Roger Gent
- Division of Medical Imaging; Women's and Children's Hospital; South Australia Australia
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Trichobezoar Causing Airway Compromise during Esophagogastroduodenoscopy. Case Rep Med 2015; 2015:806857. [PMID: 26457086 PMCID: PMC4589580 DOI: 10.1155/2015/806857] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/07/2015] [Indexed: 02/07/2023] Open
Abstract
Objectives. (1) Report the case of a 5-year-old female with trichotillomania and trichophagia that suffered airway compromise during esophagogastroduodenoscopy for removal of a trichobezoar. (2) Provide management recommendations for an unusual foreign body causing extubation and partial airway obstruction. Methods. Case report of a rare situation of airway compromise caused by a trichobezoar. Results. A 5-year-old patient underwent endoscopic retrieval of a gastric trichobezoar (hairball) by the gastroenterology service under general endotracheal anesthesia in a sedation unit. During removal, the hairball, due to its large size, dislodged the endotracheal tube, effectively extubating the patient. The bezoar became lodged at the cricopharyngeus muscle. Attempts to remove the bezoar or reintubation were unsuccessful. The child was able to be mask ventilated while the otolaryngology service was called. Direct laryngoscopy revealed a hairball partially obstructing the view of the glottis from its position in the postcricoid area. The hairball, still entrapped in the snare from the esophagoscope, was grasped with Magill forceps and slowly extracted. The patient was then reintubated and the airway and esophagus were reevaluated. Conclusions. Trichobezoar is an uncommon cause of airway foreign body. Careful attention to airway management during these and similar foreign body extractions can prevent inadvertent extubations.
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Abstract
Bezoars are concretions of human or vegetable fibers that accumulate in the gastrointestinal tract. Trichobezoars are common in patients with underlying psychiatric disorders who chew and swallow their own hair. Rapunzel syndrome is a rare form of gastric trichobezoar with a long tail extending into the small bowel. This syndrome was first described in 1968 by Vaughan et al. and since then till date just 64 cases have been described in the literature. We present the only documented case with Rapunzel syndrome in Egypt.
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Affiliation(s)
- Ahmed Youssef Altonbary
- Department of Hepatology and Gastroenterology, Mansoura Specialized Medical Hospital, Mansoura, Egypt
| | - Monir Hussein Bahgat
- Department of Hepatology and Gastroenterology, Mansoura Specialized Medical Hospital, Mansoura, Egypt
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Czerwińska K, Bekiesińska-Figatowska M, Brzewski M, Gogolewski M, Wolski M. Trichobezoar, rapunzel syndrome, tricho-plaster bezoar - a report of three cases. Pol J Radiol 2015; 80:241-6. [PMID: 26000069 PMCID: PMC4428316 DOI: 10.12659/pjr.893478] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 02/10/2015] [Indexed: 11/24/2022] Open
Abstract
Background Trichobezoar is an uncommon entity observed mostly in young women. Symptoms in presenting patients are usually due to the large mass of the bezoar or malabsorption of nutrients. Trichobezoar is almost always associated with trichotillomania and trichophagia. Case Report Three teenage girls, aged 13, 15, and 16, were diagnosed due to palpable epigastric masses. Additionally the oldest patient presented with symptoms of ileus while the other two patients had weight loss and anaemia. Besides the 15-year-old patient complained of paroxysmal abdominal pains. Patients were subjected to plain radiographic examinations of abdomen which revealed large epigastric tumours, with additional calcifications observed in the youngest girl. Subsequent gastroscopy (the 15-year-old patient) or ultrasonographic examination and computed tomography scans (13- and 16-year-old patients) allowed to establish the diagnosis of giant bezoars: trichobezoars in two older patients and tricho-plaster bezoar in the youngest one. All the tumours were surgically resected and psychiatric treatment was undertaken. Conclusions 1. Trichobezoar should be taken into consideration in differential diagnosis of epigastric tumours in children, especially teenage girls. 2. The conventional ultrasonographic and radiographic examinations of the abdomen are insufficient for determination of the nature of the mass. A thorough medical history interview and clinical examination may give directions regarding the further diagnosis.3. Trichotillomania and trichophagia are obsessive-compulsive disorders, and therefore patients with trichobezoars should be under psychiatric care to prevent recurrence of the disease.
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Affiliation(s)
- Katarzyna Czerwińska
- Department of Paediatric Radiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Michał Brzewski
- Department of Paediatric Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Michał Gogolewski
- Clinic of Paediatric Surgery, Pediatric Urology and Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Marek Wolski
- Clinic of Paediatric Surgery, Pediatric Urology and Pediatrics, Medical University of Warsaw, Warsaw, Poland
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Mehra A, Avasthi A, Gupta V, Grover S. Trichophagia along with trichobezoar in the absence of trichotillomania. J Neurosci Rural Pract 2014; 5:S55-7. [PMID: 25540542 PMCID: PMC4271385 DOI: 10.4103/0976-3147.145204] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Trichobezoars are rarely described in the absence of trichotillomania. In this report we present a case of trichobezoar associated with trichophagia in the absence of trichotillomania. A 16-year-old girl presented to surgery outpatient with complaints of pain in abdomen and vomiting for the last 6 months. Physical examination revealed a 14 × 16 cm firm, tender, mass with smooth surface, irregular margins, which was mobile with respiration. Ultrasound abdomen revealed a bizarre lesion in the right upper and middle abdomen suggestive of gastric bezoars. Upper gastrointestinal endoscopy did not reveal any abnormality in the esophagus and showed a large mobile mass in the stomach. In view of trichobezoar, psychiatry consultation was sought. Exploration of history revealed that the patient was eating hairs and clay since early childhood. As per patient she would eat hairs thrown by others. She would like the taste of hair and had strong persistent desire to eat hair and would go out searching for the same. At times she would also eat clay. However, she denied of pulling her own hairs. Physical examination of scalp and other body parts did not show any evidence of alopecia or pulling of hair/short hair. She was managed surgically and was counseled about the consequences of eating hairs and clays and was encouraged not to eat hair. To conclude our case suggests that patients can have trichobezoar and trichophagia even in the absence of trichotillomania.
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Affiliation(s)
- Aseem Mehra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vikas Gupta
- Department of Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Plataras C, Kogos G, Dambalis A, Oeconomopoulou A, Nikas K. Unusual cause of right inguinal fossa pain; photo quiz. IRANIAN JOURNAL OF PEDIATRICS 2012; 22:564-6. [PMID: 23431413 PMCID: PMC3533164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 08/15/2011] [Accepted: 11/12/2011] [Indexed: 11/08/2022]
Affiliation(s)
- Christos Plataras
- Corresponding Author:Address: El. Venizelou 26,185 31 Piraeus, Greece. E-mail:
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