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Rapunzel syndrome:A rare case - Dr Kelkar
Rapunzel syndrome:A rare case - Dr Kelkar
Rapunzel syndrome:A rare case - Dr Kelkar
Rapunzel syndrome:A rare case - Dr Kelkar
Rapunzel syndrome:A rare case - Dr Kelkar
Rapunzel syndrome:A rare case - Dr Kelkar
Rapunzel syndrome:A rare case - Dr Kelkar
Rapunzel syndrome:A rare case - Dr Kelkar
Rapunzel syndrome:A rare case - Dr Kelkar
Rapunzel syndrome:A rare case - Dr Kelkar
Rapunzel syndrome:A rare case - Dr Kelkar
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Rapunzel syndrome:A rare case - Dr Kelkar

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Rapunzel Syndrome: The Rapunzel syndrome is an extremely rare intestinal condition in humans resulting from eating hair (trichophagia). The syndrome is named after the long-haired girl Rapunzel in the …

Rapunzel Syndrome: The Rapunzel syndrome is an extremely rare intestinal condition in humans resulting from eating hair (trichophagia). The syndrome is named after the long-haired girl Rapunzel in the fairy tale by the Brothers Grimm. Trichophagia is sometimes associated with the hair pulling disorder trichotillomania.

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  • 1. By Dr. Sanjeevanee Kelkar She is a general surgeon & for last 16 years has been working as a full time General Surgeon in a Charitable Trust Hospital in Nagpur. She is also a Senior Consultant & has been the Medical Superintendent also for last 5 years. 
  • 2.
    • Trichobezoar extending from Stomach till terminal Ileum.
    • “ Trichotillomania”
    • Trichobezoar is a rare clinical condition.
    • Stomach is the common site of occurance.
    • Intestinal obstruction due to trichobezoar is extremely rare.
    • Tricho=hair ,Bezoar=mass or ball.
    • Adolescent girls - 90%
    • H/O swallowing hair,,eating hair is found in 1:2000 children.
    • 10% patients show psychiatric abnormalities or mental retardation.
    • First case of human trichobezoar was reported by Baudamant in1779.
  • 3.
    • Problem-Stomach not able to exteriorize hair & other substances out of lumen because the friction surface is not sufficient for propulsion by peristalsis.
    • Indigestible matter trapped by mucus in stomach, forms shape of stomach gradually .
  • 4.
    • Age occurance----1year to 56 years
    • Common age---15 to 20 years & 90% girls
    • Symptoms—Epigastric pain,dyspepsia,postprandial fullness.
    • Gastric bleeding—6%.
    • Intestinal obstruction or perforation—10%
    • Iron def.anemia.
  • 5. Investigations
    • Proper history=suspicion.only
    • Xray,only barium meal if done.
    • Usg-high echogenicity of hair & presence of multiple acoustic interfaces created by trapped hair & food limits usg diagnosis.
    • Endoscopy.
    • CT & MRI.
  • 6. Ms. Poojabai Patel.(from Damoh M.P.)
    • 14 year old girl was admitted in CIIMS on 20 th July evening with acute colicky abdominal pain of 25 days duration.
    • She was persistently vomiting and was restless for 7 days.
    • Her vitals were B.P.110/70mmhg,pulse 110/mt,pale dehydrated .
    • Her xray standing abdomen revealed subacute intestinal obstruction.
    • She was managed conservatively,R.T,I/V fluids Enemas, Duphalac ,responded by passing motion, reduction in distention ,hence conservative management was continued. On 3 rd day she was again the same ,hence decided to be taken for exploratory laparotomy.
  • 7.
    • Laparotomy –grossly distended small bowel loops with multiple perforations ,adhesions ,intussusception—causing intestinal obstruction.
    • grossly dilated terminal ileum,in which some funny cordlike thing was felt.
    • perforations revealed trichobezoar.Evacuated.
  • 8.
    • Laparotomy –grossly distended small bowel loops with multiple perforations ,adhesions ,intussusception—causing intestinal obstruction.
    • grossly dilated terminal ileum,in which some funny cordlike thing was felt.
    • perforations revealed trichobezoar. Evacuated.
  • 9.
    • Multiple mesenteric Lymph nodes enlarged.
    • Resection & anastomosis was done.
    • Stomach was inspected & found huge bezoar.
    • Gastrotomy done and huge stomach –shaped trchobezoar evacuated.
    • Lavage, hemostasis,drainage & closure.
  • 10.
    • Postoperatively first 48 hours was o.k./, then bp started fluctuating ,shifted to ICU,INR deranged,
    • In spite of doing everything died after 72 hours, the pathetic ending .
  • 11.  

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