Published online May 16, 2015. doi: 10.12998/wjcc.v3.i5.466
Peer-review started: December 18, 2014
First decision: December 26, 2014
Revised: January 29, 2015
Accepted: February 9, 2015
Article in press: February 11, 2015
Published online: May 16, 2015
Processing time: 141 Days and 20.2 Hours
Trichobezoars (hair ball) are usually located in the stomach, but may extend through the pylorus into the duodenum and small bowel (Rapunzel syndrome). Rapunzel syndrome remains uncommon; with fewer than 40 cases reported. To the best of our knowledge, this case may be the first well-documented case with a length of 75 cm. They are almost always associated with trichotillomania and trichophagia or other psychiatric disorders. In the literature several treatment options are proposed, including removal by conventional laparotomy, laparoscopy and endoscopy. Herein, we are reporting an interesting case of an 18-year mentally retarded girl with history of trichotillomania and trichophagia who presented to our emergency department with a history of central abdominal pain associated with vomiting and constipation for five days. An examination showed a trichobezoar requiring emergent surgical intervention, and indicating the need for psychiatric treatment. The trichobezoar was treated successfully by laparoscopy.
Core tip: Laparoscopic management is ideal for trichobezoar due to an improved cosmetic appearance, fewer postoperative complications, and reduced hospital stay. It has a better outcome with many benefits over laparotomy and is slowly becoming the treatment of choice. After trichobezoar removal, prognosis is good if psychiatric therapy to control habitual trichophagia is successful.