Acute Presentation of Rapunzel Syndrome and a Review of Bezoars

Abstract

Bezoars have different compositions and can be subdivided into trichobezoar, phytobezoar, pharmacobezoar, lactobezoar and food bolus. The reported incidence of bezoar is 0.4% with phytobezoar being the commonest. Rapunzel syndrome is an extremely rare complication when trichobezoar crosses the pylorus to enter the duodenum, ileum and colon. We present the case of a 29-year-old female with a one-week history of abdominal pain, anorexia, nausea, vomiting, constipation, lethargy and a one-year history of increasing abdominal mass. Physical examination revealed a 20 cm palpable mass extending from the left upper quadrant to the umbilicus. Laboratory investigations demonstrated iron deficiency anemia and CT showed two well-defined foci within the gastric lumen consistent with trichobezoars. She was managed conservatively during her hospital stay and discharged home with a plan for elective laparotomy. We present this case to discuss the management of trichobezoars and to highlight the importance of early recognition of recurrence to avoid severe complications.

Keywords: bezoar; gastric bezoar; rapunzel syndrome; trichobezoar; trichophagia; trichotillomania.

Figure 1. Axial (A), coronal (B) and sagittal (C) computed tomography imaging of the abdomen and pelvis showed two well-defined foci in the distended stomach. The larger focus (yellow arrow) is seen within the gastric lumen while the second focus (red arrow) extends distally into the pyloric antrum

Figure 2. Abdominal X-ray showed progression of the trichobezoar into the caecum and ascending colon