C Wang, S Feng, J Zhang, Y Tian, Y Wu, W Wu

Abstract

Background: Rapunzel syndrome is a stomach trichobezoar with a long hairy tail that extends into the duodenum and small bowel. Endoscopy, often followed by laparotomy, and psychological intervention were all part of traditional treatment. The purpose of this study was to discuss our experience with seven cases of trichobezoars in the gastrointestinal tract. Materials and methods: A retrospective review of all cases of trichobezoar at two children's hospitals from 2010 to 2020 was performed. Demographic data, presenting complaints, imaging, surgical treatment, and subsequent management were collected. Results: All 7 patients were female, ages 4 to 13 years (mean, 9.3 years). Although multiple imaging modalities were necessary for preoperative diagnosis, most patients were accurately diagnosed without endoscopic evaluation (71%). All patients required an exploratory laparotomy for definitive treatment. At laparotomy, 3 patients were found to have post-pyloric extension of the trichobezoar (43%). No surgical complications or recurrences were discovered. Conclusions: Rapunzel syndrome should be diagnosed with a high degree of clinical suspicion, which can be established with a comprehensive history and radiographs, and laparotomy should be indicated. To avoid additional trichophagia and trichobezoars, psychiatric evaluation and management are essential.