Trichobezoar with Rapunzel Syndrome Secondary to Trichophagia in Old Age a Case Report

Abstract

Bezoars are impacted concretions of ingested non-absorbable foreign material, formed most often in the stomach and sometimes in the intestine. When the bezoar is composed of hairs it is termed a trichobezoar and when its tail is extended into the small intestine and even up to the colon, it is called Rapunzel syndrome because of its long tail, like the tresses of the fictional character it is named after. It is usually associated with prior mental illnesses such as trichophagia and trichotillomania. Treatment includes surgical removal of the trichobezoar along with psychiatric management of the associated mental illness to prevent recurrence. It is common in young teenage females, but we present a rare case of a 71 years old adult female. She presented with chief complaints of epigastric pain, dysphagia and vomiting. All laboratory investigations turned out normal but physical examination revealed a hard-movable mass in the abdomen. The patient was reluctant to reveal her habit of eating hairs, which hindered the diagnosis. Endoscopy was done which confirmed presence of a trichobezoar, tethered to the mucosa of stomach, which made it difficult to remove the bezoar with forceps. She underwent open abdominal surgery and the trichobezoar with its tail was removed. The patient recovered and is undergoing psychiatric treatment for trichophagia.