Fig 2 - uploaded by Muhammad Rashid
Content may be subject to copyright.
Source publication
Introduction
Trichobezoar is a rare disorder that almost exclusively affects young females. Up to 90% between 13 and 20 years of age. The current study aims to report and discuss a rare case of Misdiagnosis of Trichobezoar.
Case presentation
A 14-year-old girl student patient admitted to the Baxshin hospital, with a large trichobezoar filling the...
Contexts in source publication
Context 1
... a large trichobezoar filling the entire stomach, measuring 21 cm in length and 8 cm in width, with a long tail of hair extending within the pylorus into the proximal jejunum at a length of 70 cm. The mass took the shape of the stomach, and the duodenum was identified and removed. Due to this feature, "Rapunzel Syndrome" was the clear diagnosis (Fig. 2). closed the incision in two layers using 2-0 Vicryl suture and the abdomen was closed without drainage. The procedure was performed at Baxshin Hospital by a general surgeon under general anesthesia with 10 years surgical ...
Context 2
... a large trichobezoar filling the entire stomach, measuring 21 cm in length and 8 cm in width, with a long tail of hair extending within the pylorus into the proximal jejunum at a length of 70 cm. The mass took the shape of the stomach, and the duodenum was identified and removed. Due to this feature, "Rapunzel Syndrome" was the clear diagnosis (Fig. 2). closed the incision in two layers using 2-0 Vicryl suture and the abdomen was closed without drainage. The procedure was performed at Baxshin Hospital by a general surgeon under general anesthesia with 10 years surgical ...
Similar publications
Bezoars have different compositions and can be subdivided into trichobezoar, phytobezoar, pharmacobezoar, lactobezoar and food bolus. The reported incidence of bezoar is 0.4% with phytobezoar being the commonest. Rapunzel syndrome is an extremely rare complication when trichobezoar crosses the pylorus to enter the duodenum, ileum and colon. We pres...
Citations
... Severe consequences include erosion of the stomach mucosa, ulceration, and even perforation of the stomach or small intestine are more likely as a result. Moreover, problems include pancreatitis, intussusception, obstructive jaundice, protein-losing enteropathy, and even fatalities have been documented [2] Case History A 12-year old female from Jarwa,Mahendragarh,Haryana presented to emergency with abdominal pain,vomiting after meals for last 10 days. ...
... Sonography is often the initial imaging modality of choice, revealing f luid-filled structures and associated findings, such as dilated loops of the small bowel or hydrosalpinx. The final diagnosis is usually made using MRI or CT scans, which can provide detailed information about the extent, location, and characteristics of the lesion [9,11]. In this case, a combination of imaging and histopathological studies confirmed the diagnosis of the tumor. ...
Lymphangiomas in the peritoneal cavity are rare in adults, with most cases occurring in children. We present the case of a 49-year-old woman who was admitted with severe lower abdominal pain. The diagnostic assessment revealed a multiloculated cystic structure in the mesentery of the distal ileum, suggesting a lymphangioma. The patient underwent laparotomy and resection, with successful removal of the mass. Histopathological examination confirmed the diagnosis of intestinal lymphangioma, a rare benign vascular neoplasm of the small bowel. Postoperatively, the patient experienced resolution of postoperative ileus and mild back and abdominal pain, with no complaints during follow-up. Awareness of this uncommon condition is crucial for accurate diagnosis and appropriate treatment. Surgical resection, supported by radiological and histopathological investigations, is the primary treatment modality for symptomatic lymphangioma. Regular follow-up with imaging may be necessary to monitor recurrence.
... Imaging is a crucial part of the diagnostic process whenever a lipoma is believed to be present. Ultrasound, CT, and MRI are some of the helpful imaging modalities [13]. ...
The most frequent benign tumor is lipoma. About 1–4% of people have intraoral lipomas. This uncommon case report shows a large cheek lipoma misinterpreted as dental infection. A 14-year-old girl with a right cheek tumor was diagnosed and treated for a dental infection. Multiple imaging examinations complete the diagnosis. A benign lipoma, common in subcutaneous tissues but unusual in the mouth, created the lesion. A histological investigation confirmed lipoma after extraoral excision under general anesthesia utilizing an external flap. The edema did not return after surgery, which restored face symmetry. This case study shows that diagnosing and treating oral and maxillofacial edema requires extensive clinical and radiographic testing. Lipomas should be evaluated in the differential diagnosis of mouth swelling even without usual risk markers to prevent excessive treatments and delays. Surgery is recommended for lipomas since it has a low recurrence and fewer risks.
... Trichobezoar may exist in the digestive tract, which has not been identified for several years, and it becomes evident with the development of complications. Patients with trichobezoar may present with obstruction, gastrointestinal perforation, intussusception, digestive bleeding, pancreatitis, appendicitis, obstructive jaundice, and protein-losing enteropathy, and may even die [2,3]. ...
Background
Trichobezoar is an extremely rare condition characterized by a foreign body in the gastrointestinal tract (GIT) among children. The foreign body may exist in the digestive tract for several years, and it becomes evident if complications develop. The current study aimed to present 21 cases of GIT trichobezoars.
Methods
Retrospective analysis of children who were diagnosed with trichobezoars between August 2012 and December 2022. Patient demographics, clinical presentation, diagnosis, and therapy were collected and analyzed.Twenty-one patients had GIT trichobezoars. Data were collected and analyzed retrospectively.
Results
Twenty-one patients were identified. All patients were female. Their mean age at admission was 8.9 ± 1.9 years. Furthermore, 19 (90.5%) patients presented with abdominal pain, 16 (76.2%) with vomiting, and 13 (61.9%) with a palpable mass. Sixteen patients underwent gastroduodenoscopy. Among them, 15 had gastric trichobezoars. Moreover, 12 patients underwent computed tomography scan. Eight patients presented with gastric and small intestinal BZs, one presented with increased small intestinal contents with dilation, and one presented with abundant gastric contents. Then, 20 patients underwent surgery. Among them, five underwent laparoscopic-assisted minilaparotomy (LAML), and the rest underwent laparotomy. The results showed that 10 (50%) patients had gastric trichobezoars; 7 (35%), Rapunzel syndrome; and 3 (15%), small bowel trichobezoars. Two patients developed superficial wound infection postoperatively. One patient had a recurrent gastric trichobezoar.
Conclusion
Trichobezoar should be considered in young girls with a history of hair eating or those with hair in the vomit or feces. Timely diagnosis and aggressive treatment are the keys to reducing complications and improving prognosis. Laparoscopic-assisted minilaparotomy is a safe, feasible, and effective surgical method for treating trichobezoars.
... During the clinical examination, a well-defined, smooth, firm, and mobile abdominal mass is present in 85 % of cases at the epigastric level. Alopecia, characterized by hair loss, may also be observed [10]. However, in the case of our patient, no abdominal mass or alopecia is present. ...
Introduction and importance
The Rapunzel syndrome embodies an uncommon variation of trichobezoar, predominantly observed among individuals with a history of psychiatric conditions, trichotillomania, and trichophagia. This combination of factors predisposes to the eventual formation of gastric bezoars. Trichobezoars, infrequent gastric masses composed of hair, can lead to complications if left untreated.
Case report
A 19-year-old female hairdresser with a history of trichophagia sought medical attention due to abdominal pain and episodes of vomiting. With an elevated body temperature and abdominal rigidity, imaging revealed the presence of a trichobezoar, accompanied by pneumoperitoneum and intraperitoneal effusion. Urgent surgical intervention confirmed the diagnosis of generalized purulent acute peritonitis, triggered by a gastric perforation caused by a 20 cm trichobezoar with an extension into the duodenum, which defines the Rapunzel syndrome. Gastrotomy was performed to remove the trichobezoar, followed by thorough peritoneal lavage.
Clinical discussion
Trichobezoar is a rare condition that involves the abnormal accumulation of solid substances, particularly hair, within the stomach. Known as “Rapunzel syndrome,” it can extend into the duodenum or jejunum. Commonly associated with emotional disorders, trichobezoar can lead to symptoms like epigastric discomfort, vomiting, and weight loss. Diagnosis is through endoscopy, and treatments include fluid intake, endoscopic extraction, chemical dissolution, and surgical removal. Surgical intervention is often preferred, with laparoscopic approaches considered. Psychiatric management is often required for patients.
Conclusion
This case underscores the uncommon Rapunzel syndrome presentation, emphasizing timely surgical measures and multidisciplinary care for trichobezoars causing acute peritonitis.
... Later, the preferred imaging modalities for diagnosing SCs were US, CT, and MRI [10,17]. These imaging findings and the elevated serum CA19-9 level strongly suggested an epithelial cyst, either epidermoid or lymphoepithelial [18]. ...
Histologically benign splenic cysts (SCs) resemble splenic sacs. SCs are rare. Here, we present and discuss a new case of bilateral endometriotic cystic ovaries with massive SCs. A 26-year-old single female visited the hospital with left lower quadrant discomfort and suprapubic pain for three months, accompanied by anorexia, weight loss for these three months, and persistent dysmenorrhea for two years. Splenic examination revealed a soft abdomen with left hypochondria, suprapubic tenderness, and a lump in the upper left quadrant. All laboratory results were normal, except for two cancer antigens (CA-125 and CA 19-9). Therefore, magnetic resonance imaging was used to make the definitive diagnosis, which revealed bilateral ovarian endometrioma with a left upper abdominal cystic mass of splenic origin. When CA-125 and CA-19-9 readings are high, physicians should investigate endometriotic and SCs. Imaging aids diagnosis. Histopathological results are essential. Tools and follow-up should rule out malignancy, and surgery is the best treatment option.
... The acidic content of the stomach denatures hair protein and gives trichobezoar its black colour and subsequent colonization by bacteria results in halitosis in patient [4,5]. Trichobezoars usually reside in the stomach but rarely may pass to the small bowel as isolated or satellite concurrent small bowel bezoars and cause intestinal obstruction [2][3][4][5][6][7][8][9][10][11][12]. Rapunzel syndrome is a rare type of trichobezoar, first described by Vaughan et al. in 1968 [4-6, 9], in which there is a tail-like extension of gastric trichobezoar which may extend through the pylorus into the small intestine or even colon [3-5, 9, 13-17]. ...
Background
Gastrointestinal (GI) tract bezoars are aggregates or concretions of inedible and undigested material mostly found in the stomach but can also be found elsewhere in the gastrointestinal tract. Trichobezoar, an infrequent form of bezoar seen mostly in young females, consists of a compact mass of swallowed hair. It is primarily located in the stomach but may extend through the pylorus into the duodenum and small bowel, a condition labelled as Rapunzel syndrome.
Cases presentation
In this series, we report four consecutive cases of trichobezoars in the paediatric age group, all managed at a single institution King Saud Medical City Hospital Riyadh between 2019 and 2022. All the cases were girls between the ages of ten to fourteen with psychosocial problems. All the patients had a definite mass in the epigastrium and a history of not gaining weight. One presented with intestinal obstruction. X-ray abdomen and computed tomography (CT) scan abdomen were the imaging modalities that led to the diagnosis. All patients underwent surgery with successful removal of the trichobezoar and were referred to a psychiatrist for evaluation and treatment of a psychological disorder.
Conclusion
Trichobezoar is a rare entity that should be considered as a differential diagnosis in young female patients with vague, non-specific clinical symptoms and a palpable, upper-abdominal mass. In our experience and in line with the published literature, conventional laparotomy is still the gold standard in cases of GI trichobezoars.
Along with the removal of the trichobezoar, treatment of the existing psycho-social ailment is of utmost importance and needs long-term counselling with periodic psychological evaluation in follow-up clinics to avoid recurrence.
... A history, clinical symptoms, tonsillar fossa palpation, and pain reduction after local anaesthetic in the tonsillar region are typically used to make the diagnosis of ES. Additionally, it has been suggested that CT and CBCT are the best imaging techniques for determining the location, size, shape, and angulation of the SPs as well as their closeness to nearby neurovascular structures [12][13][14][15] . ...
Unlabelled:
The stylohyoid ligament begins when the styloid process extends from the petrous temporal bone in a thin bony protrusion. Eagle's syndrome (ES) is a condition related to either calcification of the calcifying the stylohyoid ligament or elongating styloid process The incidence of symptomatic ES is 0.16%, and it is more common in women. The reported study diagnosed ES and treated it surgically through transoral approach styloidectomy.
Case presentation:
A 39-year-old man who is a farmer and a driver was presented with complaints of ongoing, excruciating discomfort in the back of his left ear. Before the exam, he took a variety of drugs, various drugs 2 years without receiving a definitive diagnosis. Axial, coronal, and sagittal computed tomography scans of both petrous bones were analyzed, and the results showed aberrant styloid process elongation and calcification of the stylohyoid ligament.
Discussion:
ES, shares many symptoms with other regional illnesses. Physicians frequently misdiagnose cases of ES and treat them without providing a conclusive diagnosis or treatment.
Conclusion:
ES diagnosis can be difficult for otolaryngologists and primary care providers due to its similarity with other regional illnesses. However, surgical intervention can result in consistent and significant symptomatic improvement when correctly diagnosed. The case presented in the report was successfully diagnosed as ES and treated surgically through transoral approach styloidectomy.
... First onset most commonly occurs in adolescence. Trichobezoar is defined as the abnormal accumulation of human hair in the stomach [2] . The majority of trichobezoars are found in young female patients (13-20 years old) with long hair. ...
Rapunzel syndrome is a rare clinical entity in pediatric patients with a history of trichotillomania and trichophagia that has only been mentioned a few times in the literature. It is characterized by abnormal gastric bezoar formation that sometimes extends to the duodenum, jejunum, or colon. Here, we present a case of a 16-year-old previously healthy female patient who had prolonged hospitalization due to complications related to a significant gastric bezoar that led to massive bleeding due to a superior mesenteric artery (SMA)-duodenal fistula successfully treated with stent graft placement. Undiagnosed trichobezoar can lead to rare and unexpected complications, such as SMA-duodenal fistula, with life-threatening hemorrhagic shock. Prompt activation of massive transfusion protocol and endovascular control of the hemorrhage was vital to successfully treating our patient.
... FB ingestion represents a common problem in everyday emergency clinical practice. Foreign bodies include a wide range of materials, from biological ones such as bones [6] and trichobezoar [7] to artificial materials such as shots and batteries. Although most swallowed foreign bodies generally travel through the GI tract without any problem, some of them can cause complications like as impaction, perforation (<1 % of patients), bleeding, obstruction, fistula formation and sepsis [4]. ...
Introduction and importance:
Ingested wooden toothpick (WT) represents a rare cause of acute abdomen. Preoperative diagnosis of ingested WT is a challenge because of its unspecific clinical presentation, the low sensitivity rate of radiological investigations and the patient's inability to often recall the event of swallowing a WT. Surgery represents the main treatment in case of ingested WT-induced complications.
Case presentation:
A 72-year-old Caucasian male presented to the Emergency Department with a two-day history of left lower quadrant (LLQ) abdominal pain, nausea, vomiting and fever. Physical examination revealed LLQ abdominal pain and rebound tenderness with muscle guarding. Laboratory tests reported high levels of C-reactive protein and neutrophilic leukocytosis. Abdominal contrast-enhanced computed tomography (CECT) showed colonic diverticulosis, wall thickening of the sigmoid colon, pericolic abscess, regional fatty infiltration, a suspicion of sigmoid perforation secondary to a foreign body. The patient underwent diagnostic laparoscopy: a sigmoid diverticular perforation caused by an ingested WT was noticed and a laparoscopic sigmoidectomy with end-to-end Knight-Griffen colorectal anastomosis, partial omentectomy and protective loop ileostomy were performed. The postoperative course was uneventful.
Clinical discussion:
The ingestion of a WT represents a rare but potentially fatal condition which may cause GI perforation with peritonitis, abscesses and other rare complications if it migrates out of the GI tract.
Conclusion:
Ingested WT may cause serious GI injuries with peritonitis, sepsis or death. Early diagnosis and treatment are crucial for reducing morbidity and mortality. Surgery is mandatory in case of ingested WT-induced GI perforation and peritonitis.
