Revelation of Rapunzel syndrome: A rare case report of gastric trichobezoar-induced acute purulent peritonitis

Anis Belhadj; Med Dheker Touati; Mohamed Raouf Ben Othmane; Fahd Khefacha; Ahmed Saidani; Faouzi Chebbi

doi:10.1016/j.ijscr.2023.108860

Revelation of Rapunzel syndrome: A rare case report of gastric trichobezoar-induced acute purulent peritonitis

Int J Surg Case Rep. 2023 Oct:111:108860. doi: 10.1016/j.ijscr.2023.108860. Epub 2023 Sep 22.

Authors

Anis Belhadj¹, Med Dheker Touati², Mohamed Raouf Ben Othmane¹, Fahd Khefacha¹, Ahmed Saidani¹, Faouzi Chebbi¹

Affiliations

¹ General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia.
² General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia. Electronic address: dhekertouati@hotmail.com.

Abstract

Introduction and importance: 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.

Case report: 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.

Clinical discussion: 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.

Conclusion: This case underscores the uncommon Rapunzel syndrome presentation, emphasizing timely surgical measures and multidisciplinary care for trichobezoars causing acute peritonitis.

Keywords: Acute peritonitis; Gastric perforation; Rapunzel syndrome; Surgical intervention; Trichobezoar; Trichophagia.

Publication types

Case Reports