Introduction and importance: Trichobezoar refers to accumulation of hair inside the stomach and most cases have associated psychiatric disorders such as o trichotillomania and trichophagia. Rapunzel syndrome is trichobezoar with extension of the tail of the trichobezoar to the small bowel resembling the Rapunzel hair. Case presentation: A 14-year-old girl presented with severe generalized abdominal pain and shock state. She had history of weight loss and anorexia for the last 6 months. Investigations showed low white blood cell count, low platelets, and low albumin. Computed tomography scan showed distended bowel loops with free air in the peritoneal and evidence of trichobezoar. Clinical discussion: Laparotomy showed small bowel perforation at the proximal jejunum that was closed using slowly-absorbable suture material. A large ball of hair was extracted from the stomach with a long tail of hair that extends to the proximal bowel was extracted gradually from the bowel with a total length of 135 cm. She developed anemia, hypokalemia, hypocalcemia, and hypoalbuminemia which were corrected by replacement. She also developed raised pancreatic enzymes and superficial surgical site infection after surgery. She was discharged after 8 days from presentation. Conclusion: Trichobezoar is usually underdiagnosed and the majority of cases are diagnosed with endoscopy or Computed tomography scan if performed before surgery. Cases that present with emergency presentations are diagnosed intraoperatively. Successful surgical extraction is the main part of the management, closure of the gastric or bowel perforation when present and patients with features of malnutrition will require nutritional support and close follow up. Psychiatric treatment is usually required after surgery.
Mohammed et al. (Tue,) studied this question.