Fig 1 - uploaded by Jiledar Rawat
Content may be subject to copyright.
Extracted specimen of trichobezoar A gastrotomy w a s done b y extending the i n c i s i o n f r o m the l o w e r e d g e of perforation, and t r i c h o b e z o a r extracted enmasse. The edges of perforation were freshened and g a s t r o t o m y closed in two layers over an omental patch. "Ihe abscess cavities were drained and the adhesions lysed. The child m a d e an u n e v e n t f u l r e c o v e r y a n d w a s r e f e r r e d to the psychiatrists for further management. DISCUSSION Trichobezoar results from an advertant or inadvertant swallowing of hair. Majority of the patients swallow their o w n hair. It is unclear w h y this perverted habit occurs,
Source publication
A rare case of 10-year-old female child with recurrent trichobezoar stomach is reported, which presented with features of gastric outlet obstruction with perforation.
Citations
... RS was first described in literature by Vaughan et al. in 1968. [2] Most cases of RS are reported by surgeons, pediatricians, and gastroenterologists. [6][7][8][9][10][11][12][13] Very few cases are reported in psychiatric literature. An explanation for such disparity is due to the fact that most cases of Trichotillomania are referred to psychiatrist early before the development of rs. ...
... The commonest presenting symptoms are abdominal pain, nausea, early satiety, and vomiting. [6][7][8][9][10][11][12][13] An upper abdominal mass remains the commonest presenting sign. [18] The signs and symptoms are due to mechanical effect of the mass and malabsorption of different nutrients. ...
... Other less common presenting features are gastrointestinal ulceration, obstruction, hemorrhage, perforation with peritonitis, acute pancreatitis, obstructive jaundice, and gastric emphysema. [12] Other malabsorption related complications include protein losing enteropathy, iron deficiency, and megaloblastic anemia. The gastrointestinal perforation and peritonitis are largely responsible for mortality which is about 30%. ...
Trichobezoar is a collection of dense mass of hair in stomach and when this extends into small intestine it is called Rapunzel syndrome (RS). We report here, a case of RS in an adolescent girl who had presented with epigastric pain and swelling. Gastroscopy confirmed the presence of trichobezoar. She underwent upper midline laparotomy with gastrotomy and a large dense mass of hair. Extending up to first part of duodenum was removed. Her parents revealed their daughter's impulsive nature of scalp-hair Pulling. Following surgery, psychiatric consultation was sought to prevent recurrence. Trichobezoar is a very rare cause of upper abdominal mass and should be considered if there is a very strong history of impulsive hair pulling. Surgical removal of a large trichobezoar is the only treatment of cure followed by psychiatric treatment and counseling to prevent recurrence.
... Trichobezoar is generally a problem of young females under the age of 30 years and is uncommon in the children. 5 The most common location of the trichobezoar is stomach. History of trichotillomania is usually reported in one third of the cases. ...
Trichobezoar is very uncommon in the pediatric age group. Till now no familial predisposition has been reported. We hereby report our clinical experience with eight years old twin sisters one of whom had a huge gastric trichobezoar and other one had a history of trichotillomania with recurrent vomiting and weight loss. An eight years old female child, one of the twin, presented with history of recurrent vomiting. Abdominal examination revealed firm mass in epigastric region. X-ray abdomen showed the transverse colon pushed down. Ultrasonography revealed echogenic mass in the stomach. Preoperative diagnosis of trichobezoar was achieved by a computed tomography (CT) scan. Laparotomy was done through the midline abdominal incision after initial session of resuscitation. A huge mass of hair was retrieved from the stomach part of which was passing into the duodenum. Patient was found to have underlying trichotillomania and obsessive compulsive disorder. As the patient was one of the twins, other sibling was called and evaluated for the mental health. Interestingly, she was found to have trichotillomania and trichophagia. Examination revealed sparse scalp hair. X-ray and the sonography of the abdomen were normal. Patient was advised endoscopic examination which the guardian of the patient refused. Patient was put on outpatient department (OPD) follow up after psychiatric counselling. Trichobezoar should be suspected in a pediatric patient of gastrointestinal symptoms, epigastric mass and anemia with history of trichophagia. Open surgery gives optimum results. Sibling of an affected twin must be evaluated on the similar lines and managed accordingly.
... When not recognized, these can result in severe complications the most common of which are gastric or intestinal perforation. Other complications include gastric ulcer, obstruction, intussusception, obstructive jaundice, gastric emphysema, protein-losing enteropathy, iron deficiency anemia, megaloblastic anemia, and reactive pancreatitis [12]. Due to a significantly large size of trichobezoar, the blood supply to the mucosa of the stomach and part of the intestine is hampered resulting in a perforation. ...
... Not all cases of trichotillomania have trichophagia, also all of patients with trichophagia will not have trichobezoars. 7 The mass of a bezoar can lead to epigastric pain due to distention and ulceration, early satiety and loss of weight. In cases of Rapunzel syndrome, a tail present in the intestines can trigger peristaltic movements, resulting in colicky abdominal pain. ...
A rare condition characterized by trichophagia, or the swallowing of one’s own own hair, leading to a solid mass that forms in the gastrointestinal tract. The resulting blockage of the gastrointestinal tract may be fatal. The hair forms a solid mass in the digestive tract known as a trichobezoar. It causes abdominal pain and nausea, but can also present as an asymptomatic abdominal mass, progressing to abdominal obstruction and perforation. It is predominantly found in emotionally disturbed or mentally retarded youngsters. We present the youngest case of Rapunzel syndrome in the Surat Municipal Institute of Medical Education and Research Hospital, Surat, India, a 7-year-old girl who present with abdominal pain and non-tender abdominal mass.
... [1] Less commonly, patients may present with weight loss, anorexia, haematemesis and intussusception. [12,13] Complications include gastric ulceration, perforation with peritonitis, [14][15][16] obstructive jaundice, [12] acute pancreatitis [17,18] and even death. [19] We describe a retrospective series of 5 patients with trichobezoar, who presented to our unit over a 5-year period. ...
Trichobezoars are intraluminal accretions of ingested hair. Rapunzel syndrome is a rare and extreme presentation, with the trichobezoar extending into the small intestine. It is most frequently reported in children and psychiatric patients. We report a South African series of 5 patients who presented with trichobezoars. Each patient was retrospectively reviewed and analysed with regard to background, demographics, clinical presentation, diagnosis, surgical management and complications. Five female patients with a median age of 19 (range 12-27) years presented with clinical symptoms, including early satiety, intermittent vomiting with gastric outlet obstruction, abdominal pain and weight loss. The diagnosis was made by endoscopy, abdominal computed tomography (CT) imaging, barium meal examination or plain abdominal radiography. Two patients presented with sealed/contained gastric perforations, and 1 patient with a small-bowel perforation. All 5 bezoars, 2 of which consisted entirely of artificial hair extensions, extended into the jejunum, the longest measuring 1.4 m. All were removed by laparotomy. While trichobezoars are a rare entity, they may present with significant complications, such as obstructions and perforations. In view of the infection risk and considerable size of many of these bezoars, an open removal is probably safer than any minimally invasive attempt. © 2018, South African Medical Association. All rights reserved.
... Nevertheless, a definitive diagnosis of gastric bezoars is usually established by endoscopy. Furthermore, endoscopy of the duodenum is essential to rule out the possibility of Rapunzel syndrome as well as it plays a pivotal therapeutic role [28,[42][43][44][45]. In our case Xray as well as CT scan aided in diagnosing trichobezoar. ...
Bezoars are uncommon conglomerates made up of foreign bodies like vegetable fibers, hair, inspissated/formula milk, semi-fluid medications or pills etc. in the alimentary tract of humans and certain animals. These elements remain undigested by the gastric fluids resulting in their accumulation within the gastrointestinal tract, most commonly the stomach and proximal portions of the small bowel. Presented here is an unusual case of giant trichobezoar due to trichophagia in the absence of trichotillomania in a 16-year-old girl who presented with a palpable epigastric mass along with symptoms of gastric outlet obstruction.
... Severe halitosis and patchy alopecia provide clues on physical examination [5]. Complications by a large eroding or obstructing bezoar additionally include gastric ulceration, obstructive jaundice, acute pancreatitis and gastric emphysema [6,7]. Other malabsorption related complications include protein-losing enteropathy, iron deficiency, and megaloblastic anemia. ...
A bezoar is persistent, ingested material that collects within the
gastrointestinal tract. The most common type of bezoar, a gastric trichobezoar, is made
up of human hair and found in the stomach. Patients with trichobezoar often remain
asymptomatic for many years. The aim of treatment of trichobezoar is removal of
the bezoar and to prevent recurrence. Case Report: A 12 year old girl presented with
abdominal pain and vomiting. suffering from trichophagia developing trichobezoar.
Ultrasonography was suggestive of partial gastric outlet obstruction and barium swallow
was suggestive of bezoar in gastric lumen. Conclusion: Trichobezoar should be considered
in young females presenting with non-specific abdominal complai
... Other clinical features may be anorexia, weight loss, blood in vomitus, intussusceptions. [6,7,15,16] Section: Surgery CASE REPORT 24 year old girl presented to the emergency department of Teerthankar Mahaveer medical college and research centre with diffuse abdominal pain, vomiting and abdominal distention from past 10 days duration, constipation from 15 days. No history of any previous illness, abdominal surgeries, abdominal injuries or allergies was found. ...
... Other clinical features may be anorexia, weight loss, blood in vomitus, intussusceptions. [6,7,15,16] Large size bezoar can lead to decrease in blood flow to the mucosa of stomach/ small intestine leading to mucosal erosion, ulceration and sometimes perforation. Obstruction at second part of duodenum where there is opening of papilla, may lead to obstructive jaundice and pancreatitis. ...
... The complications of the Rapunzel syndrome ranges from attacks of incomplete pyloric obstruction to rarely complete obstruction of the bowel to perforation to peritonitis and mortality [34,35]. Bleeding, perforation, protein losing enteropathies, steatorrhea, pancreatitis, appendicitis, and/or intussusceptions may occur363738. We believe that -after MEDLINE search along the last 10 years-this is the first Egyptian case presentation of Rapunzel syndrome in a child with autoimmune liver disease (primary biliary cirrhosis) and trichotillomania presented at very young age (7-years). ...
Rapunzel Syndrome in a 7-year-old Egyptian Girl with Primary Biliary
Cirrhosis: A case Report and Literature Review
... Although endoscopic removal or dissolution with coca-cola have been described, we did not venture with these modalities due to the presence of a large ulcer possibly due to the pressure necrosis of gastric mucosa [4]. Surgery is the definitive modality but close psychiatric follow-up is recommended to prevent recurrence [5]. ...
