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Case Reports
. 2021 Feb 9;14(2):e240100.
doi: 10.1136/bcr-2020-240100.

Gastric perforation secondary to Rapunzel syndrome

Jamaall Jackman  1 , Gael R Nana  2 , James Catton  2 , Ioannis Christakis  2
Affiliations
Case Reports

Gastric perforation secondary to Rapunzel syndrome

Jamaall Jackman et al. BMJ Case Rep. .

Abstract

Rapunzel syndrome is rare and describes a trichobezoar that extends through the pylorus into the jejunum, ileum or even the colon. Due to the large intraluminal size and weight they can attain, acute presentations of obstruction or perforation may occur. We report a case of a 17-year-old girl who presented to the emergency department following a syncopal episode. On examination, a left upper quadrant mass was appreciated with no signs of peritonism. Contrast-enhanced CT demonstrated a giant trichobezoar with resulting gastric perforation and intra-abdominal free fluid. Laparotomy and gastrotomy were performed and the patient had an uneventful recovery with psychiatric review prior to discharge. Though uncommon, bezoars should be included in our differential diagnosis as they can present in various ways owing to their size and weight. This case illustrates the risk of gastric perforation with large gastric bezoars.

Keywords: gas/free gas; gastrointestinal surgery; nutritional support; stomach and duodenum.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Coronal contrast-enhanced CT image showing large bezoar and pneumoperitoneum.
Figure 2
Figure 2
Sagittal contrast-enhanced CT image showing large bezoar and pneumoperitoneum.
Figure 3
Figure 3
Trichobezoar specimen.
See this image and copyright information in PMC

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