Rapunzel syndrome: A rare presentation with multiple small intestinal intussusceptions

Abstract

Bezoars are usually confined to the stomach which is seen in individuals with psychiatric illness like trichotillomania, trichophagia and gastric dysmotility. Long standing bezoars may extend into the small intestine leading to a condition known as Rapunzel syndrome. Diagnosis can be established by endoscopy, ultrasonography and computed tomography scan. Treatment includes improvement of general condition and removal of bezoar by laparoscopic approach or laparotomy. Psychiatric consultation is necessary to treat and prevent relapse. We report a case of Rapunzel syndrome in a 16-year-old girl with trichotillomania. She presented with history of epigastric mass for three months and recent onset of pain abdomen, vomiting and early satiety. Skiagram of abdomen was showing distended stomach and endoscopy revealed trichobezoar. At laparotomy, stomach was distended with trichobezoar and there were multiple small intestinal intussusceptions. Gastrotomy and manual reduction of intussusceptions with the removal of trichobezoar with its tail was done. Patient recovered completely after the procedure.

Keywords: Intussusception; Rapunzel syndrome; Trichobezoar; Trichotillomania.

Figure 1

Treatment process. A: Skiagram of thorax and abdomen showing grossly distended stomach; B: Endoscopic view of trichobezoar; C: Gastrotomy showing ball of hair being removed; D: Multiple small bowel intussusceptions; E: Retrieved trichobezoar with its intestinal tail.