Psychiatric follow-up was arranged, where she showed improvement in behavior, which is key to prevent recurrence.īezoars are concretions of foreign material in the gastrointestinal tract, mainly the stomach.
The patient was discharged home 5 days later, having recovered without complications. When directly asked, the patient admitted that she liked to eat hair. Only on repeated questioning did the mother give a history of occasional trichophagia. The 11.5 cm x 6 cm x 4 cm mass was found to be a trichobezoar with a tapering tail extending into the small bowel, and was a perfect cast of the stomach, pylorus and duodenal bulb (figure 3 ▶). Gastrotomy was performed the next day and the mass removed in one piece. The CT confirmed large amounts of mottled material in the stomach, believed to be bezoar extending into the small intestine (figure 2 ▶). Plain radiograph of the abdomen showing multiple air fluid levels with dilated small intestinal loops and a sizable soft tissue density within the stomach are seen.īecause of the large size of the abdominal mass and soft tissue density on x-ray, abdominal computed tomography (CT) with contrast was performed with the concern of a possible tumor. Complete blood count, complete metabolic panel, as well as pancreatic enzymes, were normal. Laboratory work-up revealed only concentrated urine and pyuria. Plain radiograph of the abdomen showed multiple air fluid levels with dilated small intestinal loops and a sizable soft tissue density within the stomach (figure 1 ▶). The rest of the physical examination was normal. Abdominal examination revealed a hard, non-tender, ballotable mass of approximately 10 cm x 6 cm in the epigastric region extending into the right upper quadrant. The child had always been on the lower end of the growth curve with underweight compared to height. There were no changes in her bowel habits.
There was no history of acid reflux, diarrhea, increased flatulence, recent illnesses, or fever. The mother commented on early satiety and chronically decreased appetite. The child appeared to be in some discomfort but was able to communicate by sign language. She would curl up with pain after eating and then feel relief after vomiting. We present the youngest documented patient with Rapunzel syndrome in the United States.Ī 5-year-old female, born at 25 weeks gestation with bilateral sensorineural deafness and broncho-pulmonary dysplasia, presented to the emergency room with a 1.5 week history of poorly localized abdominal pain and 3 days of postprandial emesis. 6 The majority of these cases presented between 13 and 20 years of age. 5 A cotton bezoar with Rapunzel syndrome was recently reported in an 18-year-old male. One reported male case ate the hair of his sisters. Most cases of trichobezoar are reported in females, which may be attributed to the traditional long hair in females. The name “Rapunzel” syndrome comes from the Grimm Brothers’ fairy tale of a 12-year-old princess who was shut into a tower with neither stairs nor doors by an enchantress who climbed up the tower’s walls with the help of Rapunzel’s long tresses.
Rapunzel syndrome is an unusual and rare form of trichobezoar extending into the small intestine. Trichobezoars, unlike other bezoars, are not associated with alterations in gastrointestinal motility but with underlying psychiatric disorders, and most commonly present in adolescents and during the second decade of life. However, bezoars can also be made of vegetable or fruit fiber (phytobezoars), milk curd (lactobezoars), or any indigestible material. In humans, the most common type of bezoar is the trichobezoar, which is mostly made of hair. 1 The first reference to a bezoar in a human was in 1779 during an autopsy of a patient who died from gastric perforation and peritonitis. The word “bezoar” comes from the Arabic word “bedzehr” or the Persian word “padzhar,” meaning “protecting against a poison.” At different times in history, bezoars from animal guts were used as precious stones, antidotes to poisons and today as part of traditional Chinese medicine. Bezoars are concretions of human or vegetable fibers that accumulate in the gastrointestinal tract.
0 kommentar(er)
