Rapunzel Syndrome in A 13-Year-Old Girl with Abdominal Pain Presenting to The Pediatric Emergency Department: A Case Report
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Abstract
Trichobezoar is a rare form of bezoar characterized by the accumulation of swallowed hair in the stomach. An unusual form of bezoar, in which the bezoar spreads from the stomach to the small intestine or beyond, is called Rapunzel syndrome. This syndrome is mainly seen in females and is often associated with psychiatric disorders. Trichobezoar usually presents with abdominal pain, early satiety, and nausea. However, it may also present as an asymptomatic abdominal mass or obstruction and pe rforation of the gastrointestinal tract.This diagnosis should be considered in young women with abdominal pain, an epigastric mass, and malnutrition, especially in patients with a history of trichophagy or psychiatric disorder.The case of a 13-year-old girl with Rapunzel syndrome is described. She presented to the emergency ward with a history of abdominal pain, non-bilious vomiting after meal and fluid intake, halitosis, decreased appetite, and weight loss. The patient was treated successfully by laparotomy.
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[7]Wang Z, Cao F, Liu D, Fang Y, Li F. The diagnosis and treatment of Rapunzel syndrome. Acta Radiol Open. 2016;5(11):2058460115627660. https://doi.org/10.1177/20- 58460115627660
[8]Sotoudeh E, Hussain S, Shafaat O, Sotoudeh H. Fungal peritonitis with fungus balls, a complication of trichobezoars and Rapunzel syndrome. Am J Case Rep. 2019;20:685. https:// doi.org/10.12659/AJCR.915517
[9]Cannalire G, Conti L, Celoni M, Grassi C, Cella A, Bensi G, et al. Rapunzel syndrome: an infrequent cause of severe iron deficiency anemia and abdominal pain presenting to the pediatric emergency department. BMC Pediatr. 2018;18(1):1- 5. https://doi.org/10.1186/s12887-018-1097-8
[10] Parakh J, McAvoy A, Corless D. Rapunzel syndrome resulting in gastric perforation. Ann R Coll Surg Engl. 2016;98(1):e6-e7. https://doi.org/10.1308/rcsann.2016.0008
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[12] Lalith S, Gopalakrishnan KL, Ilangovan G, Jayajothi A. Rapunzel syndrome. J Clin Diagn Res. 2017;11(9):TD01. https://doi.org/10.7860/JCDR/2017/28593.10594
[13] Emre AU, Tascilar O, Karadeniz G, Irkorucu O, Karakaya K, Comert M. Rapunzel syndrome of a cotton bezoar in a multimorbid patient. Clinics (Sao Paulo). 2008;63(2):285-8. https://doi.org/10.1590/S1807-59322008000200021
[14] Panza KE, Pittenger C, Bloch MH. Age and gender correlates of pulling in pediatric trichotillomania. J Am Acad Child Adolesc Psychiatry. 2013;52(3):241-9. https://doi.org/10.1016/j.jaac.2012.12.019
[15] Alibraheem A, Danial A, Kazan A, Masri E, Obari MY, Basha SR. Rapunzel Syndrome in Congenital Mental Retardation Patient Requiring Emergency Laparotomy. Case report. Ann Med Surg (Lond). 2020;58:99-101. https://doi.org/10.1016/j.amsu.2020.08.026
[16] Pogorelic Z, Juric I, Zitko V, Britvic-Pavlov S, Biocic M. Unusual cause of palpable mass in upper abdomen-giant gastric Trichobezoar: report of a case. Acta Chir Belg. 2012;112(2):160- 3. https://doi.org/10.1080/00015458.2012.11680816
[17] Vellaisamy R, Iyer S, Chandramohan SM, Harikrishnan S. Rapunzel syndrome with cholangitis and pancreatitis-A rare case report. Open Med (Wars). 2020;15(1):1137-42. https://doi.org/10.1515/med-2020-0243
[18] Harikrishnan S, Perumal S, Sachanandani K, Thiruvarul M, Sugumar C, Sathyanesan J, et al. A modified laparoscopic technique for the removal of nonfragmentable giant gastric Trichobezoar. Niger J Surg. 2020;26(1):84. https://doi.org/10.4103/njs.NJS_20_19
disease: physiology, diagnosis, management. PMPH USA, Ltd; 2018. p. 5016-8.
[2]Sarsu SB, Kapur A. An unusual reason of abdominal pain: A case of Rapunzel’s syndrome and literature review. Med Sci Discov. 2016;3(2):112-5. https://doi.org/10.17546/msd.32281
[3]Eng K, Kay M. Gastrointestinal bezoars: history and current treatment paradigms. Gastroenterol Hepatol (N Y).
2012;8(11):776.
[4]Gonuguntla V, Joshi D-D. Rapunzel syndrome: a comprehensive review of an unusual case of Trichobezoar. Clin Med Res. 2009;7(3):99-102. https://doi.org/10.3121/cmr.2009.822
[5]Caiazzo P, Di Lascio P, Crocoli A, Del Prete I. The Rapunzel syndrome. Report of a case. Il G Chir. 2016;37(2):90. https://
doi.org/10.11138/gchir/2016.37.2.090
[6]Kim SC, Kim SH, Kim SJ. A case report: large Trichobezoar causing Rapunzel syndrome. Medicine (Baltimore). 2016;95(22). https://doi.org/10.1097/MD.0000000000003745
[7]Wang Z, Cao F, Liu D, Fang Y, Li F. The diagnosis and treatment of Rapunzel syndrome. Acta Radiol Open. 2016;5(11):2058460115627660. https://doi.org/10.1177/20- 58460115627660
[8]Sotoudeh E, Hussain S, Shafaat O, Sotoudeh H. Fungal peritonitis with fungus balls, a complication of trichobezoars and Rapunzel syndrome. Am J Case Rep. 2019;20:685. https:// doi.org/10.12659/AJCR.915517
[9]Cannalire G, Conti L, Celoni M, Grassi C, Cella A, Bensi G, et al. Rapunzel syndrome: an infrequent cause of severe iron deficiency anemia and abdominal pain presenting to the pediatric emergency department. BMC Pediatr. 2018;18(1):1- 5. https://doi.org/10.1186/s12887-018-1097-8
[10] Parakh J, McAvoy A, Corless D. Rapunzel syndrome resulting in gastric perforation. Ann R Coll Surg Engl. 2016;98(1):e6-e7. https://doi.org/10.1308/rcsann.2016.0008
[11] Vaughan Jr E, Sawyers J, Scott Jr H. The Rapunzel syndrome. An unusual complication of intestinal bezoar. Surgery. 1968;63(2):339-43.
[12] Lalith S, Gopalakrishnan KL, Ilangovan G, Jayajothi A. Rapunzel syndrome. J Clin Diagn Res. 2017;11(9):TD01. https://doi.org/10.7860/JCDR/2017/28593.10594
[13] Emre AU, Tascilar O, Karadeniz G, Irkorucu O, Karakaya K, Comert M. Rapunzel syndrome of a cotton bezoar in a multimorbid patient. Clinics (Sao Paulo). 2008;63(2):285-8. https://doi.org/10.1590/S1807-59322008000200021
[14] Panza KE, Pittenger C, Bloch MH. Age and gender correlates of pulling in pediatric trichotillomania. J Am Acad Child Adolesc Psychiatry. 2013;52(3):241-9. https://doi.org/10.1016/j.jaac.2012.12.019
[15] Alibraheem A, Danial A, Kazan A, Masri E, Obari MY, Basha SR. Rapunzel Syndrome in Congenital Mental Retardation Patient Requiring Emergency Laparotomy. Case report. Ann Med Surg (Lond). 2020;58:99-101. https://doi.org/10.1016/j.amsu.2020.08.026
[16] Pogorelic Z, Juric I, Zitko V, Britvic-Pavlov S, Biocic M. Unusual cause of palpable mass in upper abdomen-giant gastric Trichobezoar: report of a case. Acta Chir Belg. 2012;112(2):160- 3. https://doi.org/10.1080/00015458.2012.11680816
[17] Vellaisamy R, Iyer S, Chandramohan SM, Harikrishnan S. Rapunzel syndrome with cholangitis and pancreatitis-A rare case report. Open Med (Wars). 2020;15(1):1137-42. https://doi.org/10.1515/med-2020-0243
[18] Harikrishnan S, Perumal S, Sachanandani K, Thiruvarul M, Sugumar C, Sathyanesan J, et al. A modified laparoscopic technique for the removal of nonfragmentable giant gastric Trichobezoar. Niger J Surg. 2020;26(1):84. https://doi.org/10.4103/njs.NJS_20_19
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| Issue | Vol 8 No 4 (2023): July-August | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/crcp.v8i4.14578 | |
| Keywords | ||
| Rapunzel syndrome Abdominal pain Case report | ||
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How to Cite
1.
Aflatoonian M, Edalatkhah R, Raji H, Amel shahbaz A pasha. Rapunzel Syndrome in A 13-Year-Old Girl with Abdominal Pain Presenting to The Pediatric Emergency Department: A Case Report. CRCP. 2024;8(4):166-170.
