In Practice

Rapunzel syndrome: A South African variety

J Plaskett, G Chinnery, D Thomson, S Thomson, B Dedekind, E Jonas

Abstract


Trichobezoars are intraluminal accretions of ingested hair. Rapunzel syndrome is a rare and extreme presentation, with the trichobezoar extending into the small intestine. It is most frequently reported in children and psychiatric patients. We report a South African series of 5 patients who presented with trichobezoars. Each patient was retrospectively reviewed and analysed with regard to background, demographics, clinical presentation, diagnosis, surgical management and complications. Five female patients with a median age of 19 (range 12 - 27) years presented with clinical symptoms, including early satiety, intermittent vomiting with gastric outlet obstruction, abdominal pain and weight loss. The diagnosis was made by endoscopy, abdominal computed tomography (CT) imaging, barium meal examination or plain abdominal radiography. Two patients presented with sealed/contained gastric perforations, and 1 patient with a small-bowel perforation. All 5 bezoars, 2 of which consisted entirely of artificial hair extensions, extended into the jejunum, the longest measuring 1.4 m. All were removed by laparotomy. While trichobezoars are a rare entity, they may present with significant complications, such as obstructions and perforations. In view of the infection risk and considerable size of many of these bezoars, an open removal is probably safer than any minimally invasive attempt.


Authors' affiliations

J Plaskett, Department of Surgery, Faculty of Health Sciences, Groote Schuur Hospital and University of Cape Town, South Africa

G Chinnery, Department of Surgery, Faculty of Health Sciences, Groote Schuur Hospital and University of Cape Town, South Africa

D Thomson, Department of Surgery, Faculty of Health Sciences, Groote Schuur Hospital and University of Cape Town, South Africa

S Thomson, Department of Surgery, Faculty of Health Sciences, Groote Schuur Hospital and University of Cape Town, South Africa

B Dedekind, Netcare Christiaan Barnard Memorial Hospital, Cape Town, South Africa

E Jonas, Department of Surgery, Faculty of Health Sciences, Groote Schuur Hospital and University of Cape Town, South Africa

Full Text

PDF (2008KB)

Keywords

Surgery; Rapunzel syndrome; Trichobezoar; South Africa; Case series

Cite this article

South African Medical Journal 2018;108(7):559-562. DOI:10.7196/SAMJ.2018.v108i7.13115

Article History

Date submitted: 2018-06-26
Date published: 2018-06-26

Article Views

Abstract views: 685
Full text views: 438

Comments on this article

*Read our policy for posting comments here