Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2017; 5(2): 50-55
Published online Feb 16, 2017. doi: 10.12998/wjcc.v5.i2.50
Rapunzel syndrome is not just a mere surgical problem: A case report and review of current management
Obinna Obinwa, David Cooper, Faraz Khan, James M O’Riordan
Obinna Obinwa, David Cooper, Faraz Khan, James M O’Riordan, Department of Surgery, the Adelaide and Meath Hospital, Dublin Incorporating the National Children’s Hospital, Tallaght, Dublin 24, Ireland
Author contributions: All authors contributed to the acquisition of data, writing, and revision of this manuscript.
Institutional review board statement: Not applicable.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and accompanying images.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Obinna Obinwa, MCh, MRCSI, Department of Surgery, the Adelaide and Meath Hospital, Dublin Incorporating the National Children’s Hospital, Tallaght, Dublin 24, Ireland.
Telephone: +353-1-4142211 Fax: +353-1-4142212
Received: September 15, 2016
Peer-review started: September 19, 2016
First decision: November 14, 2016
Revised: December 7, 2016
Accepted: December 27, 2016
Article in press: December 28, 2016
Published online: February 16, 2017

Recurrent Rapunzel syndrome (RRS) is a rare clinical presentation with fewer than six cases reported in the PubMed literature. A report of RRS and literature review is presented. A 25-year-old female was admitted to hospital with a 4-wk history of epigastric pain and swelling. She had a known history of trichophagia with a previous admission for Rapunzel syndrome requiring a laparotomy nine years earlier, aged 16. Psychological treatment had been successfully achieved for nine years with outpatient hypnotherapy sessions only, but she defaulted on her last session due to stressors at home. The abdominal examination demonstrated an epigastric mass. Computer tomography scan revealed a large gastric bezoar and features of aspiration pneumonia. The patient underwent emergency open surgical laparotomy for removal as the bezoar could not be removed endoscopically. The bezoar was cast in a shape that mimicked the contours of the stomach and proximal small bowel, hence the diagnosis of RRS. The patient was seen by a psychiatrist and was commenced on Quetiapine before discharge. She continues to attend follow-up.

Keywords: Trichobezoars, Rapunzel syndrome, Recurrence, Obsessive compulsive disorders, Case report

Core tip: There remain to be clear guidelines on the management of trichotillomania associated disorders. Here we report that Rapunzel syndrome requires a comprehensive and long-term psychiatric follow-up as it is not a primary surgical condition. A late relapse of the condition is possible and recognizing this as a clinical possibility can intensify efforts in relapse prevention during the follow-up period. This approach is important in eliminating the need for recurrent surgical interventions and associated morbidity. Multidisciplinary health care teams headed by a psychiatrist as well as family support play a key role in the prevention of recurrence.