Trichobezoar presenting as a gastric outlet obstruction: A case report

Abstract

Introduction: Rapunzel syndrome is a rare intestinal condition that starts with the ingestion of a trichobezoar. The condition is predominately found in females and can be associated with trichotillomania, or the compulsive urge to pull one's own hair out. There are less than 40 cases described in the literature with the prevention of recurrence aimed at psychological treatment.

Presentation of case: The patient is a 7 year-old girl with a history of trichotillomania with trichophagia as a young child who presented with abdominal pain, nausea, and vomiting, consistent with a gastric outlet obstruction. She had an exploratory laparotomy with gastrostomy performed revealing a 18cm by 18cm trichobezoar with extension into the small bowel.

Discussion: Bezoars, an already rare entity, can occasionally lead to gastric and small bowel obstructions. Small collections of ingested hair build up in the intestinal tract causing significant symptoms. These obstructions can sometimes be treated through minimally invasive techniques but, in our case described, it is unlikely to have been treated any other way due to the substantial size of the trichobezoar.

Conclusion: Early consideration of Rapunzel syndrome is important in young females presenting with a gastric outlet obstruction.

Keywords: Case report; Gastric mass; Laparotomy; Rapunzel syndrome; Trichobezoar; Trichotillomania.

Fig. 1

Upright X-ray of patient presenting with Trichobezoar.

Fig. 2

Extracorporeal stomach filled with trichobezoar (continued).

Fig. 3

Gastrotomy with trichobezoar.

Fig. 4

Trichobezoar specimen with tail removed from duodenum.

Fig. 5

Extracorporeal stomach filled with trichobezoar.