Belhadj Anis, Touati Med Dheker, Othmane Mohamed Raouf Ben, Khefacha Fahd, Saidani Ahmed, Chebbi Faouzi
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.
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.
Int J Surg Case Rep. 2023 Oct;111:108860. doi: 10.1016/j.ijscr.2023.108860. Epub 2023 Sep 22.
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.
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.
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.
This case underscores the uncommon Rapunzel syndrome presentation, emphasizing timely surgical measures and multidisciplinary care for trichobezoars causing acute peritonitis.
长发公主综合征是毛粪石的一种罕见变异形式，主要见于有精神疾病、拔毛癖和食毛癖病史的个体。这些因素共同作用易导致最终胃内形成毛粪石。毛粪石是由毛发组成的罕见胃内肿物，若不治疗可导致并发症。
一名19岁有食毛癖病史的女性美发师因腹痛和呕吐发作前来就医。体温升高且伴有腹部强直，影像学检查显示存在毛粪石，并伴有气腹和腹腔积液。紧急手术干预证实为广泛性化脓性急性腹膜炎，由一个20厘米长且延伸至十二指肠的毛粪石导致胃穿孔引起，这符合长发公主综合征的特征。实施胃切开术以取出毛粪石，随后进行彻底的腹腔灌洗。
毛粪石是一种罕见病症，涉及胃内固体物质尤其是毛发的异常积聚。它被称为“长发公主综合征”，可延伸至十二指肠或空肠。毛粪石通常与情绪障碍相关，可导致上腹部不适、呕吐和体重减轻等症状。诊断通过内镜检查，治疗方法包括补充液体、内镜下取出、化学溶解和手术切除。通常首选手术干预，可考虑采用腹腔镜手术方式。患者通常需要进行精神科管理。
本病例强调了罕见的长发公主综合征表现，强调对于导致急性腹膜炎的毛粪石应及时采取手术措施并进行多学科护理。
