Obstruction of Small Bowel Caused by Unconscious Trichotillomania: Rapunzel Syndrome
Rapunzel syndrome is a relatively rare condition in which swallowed hair
masses extend to a point distal to the pylorus and cause intestinal problems.
Although trichotillomania and trichophagia are secondary to psychiatric illnesses,
these conditions tend to be concealed by caregivers in most pediatric cases.
Rapunzel syndrome sometimes manifests as acute abdominal symptoms of unknown
origin and is difficult to manage appropriately.
The patient underwent exploratory laparotomy, and hairballs were removed via an incision of the
gastric and intestinal walls.
The patient recovered uneventfully and was discharged on the 11th post-operative day.
Periodical psychiatric counseling is ongoing in order to prevent recurrence.
Pediatric trichotillomania often progresses unconsciously, and appropriate care is necessary
to prevent the development of a potentially fatal condition like Rapunzel syndrome.
CECT is useful for making a definitive diagnosis of Rapunzel syndrome and determining
the surgical approach.
The large trichobezoar is the result of long-term trichotillomania and trichophagia
due to underlying psychological problems.
In addition to making a definitive diagnosis, the detection of the location
of the masses is necessary for complete removal.
Appropriate psychiatric care is necessary for further prevention after acute-phase treatment.
Emerg Med Open J. 2017; 3(2): 54-57. doi: 10.17140/EMOJ-3-142