UNASSIGNED: Rapunzel syndrome is a rare trichobezoar variant extending from the gastric cavity into the small bowel.
UNASSIGNED: We report the case of a 22-year-old woman who presented with epigastric pain, nausea, and loss of appetite within the preceding five weeks. She had a palpable mass in the epigastric area with mild localized tenderness. Her abdominal computed tomography scan showed a distended stomach and duodenum, with a heterogeneous solid material, suspicious for a bezoar. Upper gastrointestinal endoscopy revealed a large, densely packed trichobezoar occupying the gastric cavity and extending through the pylorus. Endoscopic removal of the bezoar was unsuccessful. The patient underwent a 6cm-long gastrotomy, and the 150cm-long bezoar, extending from the stomach to the jejunum, was uneventfully removed. The patient was referred postoperatively to a dietitian and psychiatrist for management of her trichotillomania and trichophagia.
UNASSIGNED: Trichobezoars are commonly found in young females with a history of trichotillomania and trichophagia and are associated with psychiatric disorders. HIPPOKRATIA 2023, 27 (1):25-27.

Trichobezoar is a relatively rare condition in children, mainly observed in young girls with psychiatric disorders. While documented cases of trichobezoar associated with celiac disease exist, such occurrences remain uncommon in the literature. The association between the two can be explained either by behavioral disorders resulting from a deficiency in iron and folic acid or directly by celiac disease. Treatment is predominantly surgical, and psychological support plays a crucial role in preventing the likelihood of recurrence. We present an unusual case involving the discovery of gastric trichobezoar in a 15-year-old girl who had undiagnosed celiac disease. The condition manifested after she experienced abdominal pain and pallor.

Rapunzel syndrome is a rare disorder characterized by a trichobezoar in the gastroduodenal tract caused by trichophagia. Diagnosis was confirmed by upper endoscopy and treatment was surgical.

This case study delves into the unique presentation of bezoars in a 14-year-old autistic female who exhibited chronic diarrhea and abdominal pain. While trichobezoars, masses formed from ingested hair, are rare, they are predominantly seen in young females and are associated with psychiatric conditions. Through rigorous diagnostic procedures, including a computed tomography imaging of the abdomen and pelvis (CTAP) scan, fecal impaction, and multiple bezoars, including hair and non-biological items, were identified. The background revealed significant neglect, emphasizing the importance of a comprehensive approach that integrates medical, surgical, and psychosocial care.

UNASSIGNED: The Rapunzel syndrome embodies an uncommon variation of trichobezoar, predominantly observed among individuals with a history of psychiatric conditions, trichotillomania, and trichophagia. This combination of factors predisposes to the eventual formation of gastric bezoars. Trichobezoars, infrequent gastric masses composed of hair, can lead to complications if left untreated.
METHODS: A 19-year-old female hairdresser with a history of trichophagia sought medical attention due to abdominal pain and episodes of vomiting. With an elevated body temperature and abdominal rigidity, imaging revealed the presence of a trichobezoar, accompanied by pneumoperitoneum and intraperitoneal effusion. Urgent surgical intervention confirmed the diagnosis of generalized purulent acute peritonitis, triggered by a gastric perforation caused by a 20 cm trichobezoar with an extension into the duodenum, which defines the Rapunzel syndrome. Gastrotomy was performed to remove the trichobezoar, followed by thorough peritoneal lavage.
UNASSIGNED: Trichobezoar is a rare condition that involves the abnormal accumulation of solid substances, particularly hair, within the stomach. Known as \"Rapunzel syndrome,\" it can extend into the duodenum or jejunum. Commonly associated with emotional disorders, trichobezoar can lead to symptoms like epigastric discomfort, vomiting, and weight loss. Diagnosis is through endoscopy, and treatments include fluid intake, endoscopic extraction, chemical dissolution, and surgical removal. Surgical intervention is often preferred, with laparoscopic approaches considered. Psychiatric management is often required for patients.
CONCLUSIONS: This case underscores the uncommon Rapunzel syndrome presentation, emphasizing timely surgical measures and multidisciplinary care for trichobezoars causing acute peritonitis.

Trichobezoars are hairballs in the gastrointestinal tract that usually develop due to the consumption of hair after pulling it. However, some rare case reports suggest that trichobezoar can also occur in the respiratory system. In this context, we present an unusual case of a 25-year-old woman who experienced dyspnea, productive cough, and leukocytosis. The patient was found to have a trichobezoar in her respiratory tract, accompanied by the presence of hair in her digestive tract.

Trichobezoars are difficult to remove endoscopically and often require surgery. We performed trans-umbilical intragastric surgery using two Alexis wound retractors with successful results in a pediatric patient with a trichobezoar. This method is a safe and cosmetically favorable option for the removal of large trichobezoars and does not require special techniques or instruments. It also contributes to the reduction of postoperative complications such as wound infection and intra-abdominal abscess.

Rapunzel syndrome with gastric perforation is an extremely rare presentation of trichobezoars of the stomach. Trichobezoars may vary greatly in presentation ranging from benign symptoms like vague abdominal pain and anorexia to grave complications like perforation peritonitis. A sincere evaluation of any underlying psychiatric illnesses, usually trichotillomania and trichophagia, holds the key to preventing recurrences in patients of trichobezoar. A 15-year-old adolescent female presented with signs and symptoms of enteric perforation with a history of trichotillomania and trichophagia. Exploratory laparotomy of the patient revealed anterior gastric perforation with a huge gastric trichobezoar that extended into the duodenum and jejunum, hence establishing the diagnosis of Rapunzel syndrome.

Gastric trichobezoars are a result of trichophagia secondary to trichotillomania, and can result in severe complications such as perforation or intussusception. We present the case of a 19-year-old female with multiple points of intussusception secondary to a large gastric/small intestine trichobezoar and describe our approach to diagnosis and eventual removal of the bezoar.

Trichobezoars are an accumulation of undigested hair in the gastrointestinal system. They are a rare finding and are more likely in young females. Diagnosis is largely dependent on history taking and imaging, and treatment involves the removal and psychiatric evaluation.  We describe the case of a 21-year-old female with a history of gastroesophageal reflux disease (GERD) who presented with abdominal pain. Imaging showed a distended stomach with a suspected swallowed foreign substance. The patient subsequently underwent midline laparotomy, gastrotomy, and bezoar extraction. Postoperatively the patient was found to have trichotillomania, trichophagia, anxiety, depression, and symptomatic anemia. Initial management of gastric bezoars includes proper removal, but the additional follow-up needs to include psychiatric evaluation and treatment to prevent reoccurrence. It is also imperative to assess and treat underlying nutritional deficiencies.