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Rapunzel syndrome

Case contributed by Mostafa Elfeky
Diagnosis probable

Presentation

Abdominal pain, failed to gain weight and sensation of hard mass at the upper abdomen.

Patient Data

Age: 20 years
Gender: Female

Abdomen

ct

A large hyperdense inhomogeneous mass is seen expanding the stomach with a mottled gas pattern and compressed concentric zones of different densities. 

Abdomen CT with oral & C+

ct

Oral and intravenous contrast revealed the well-circumscribed appearance of the intragastric mass, seen completely separable from the gastric wall and extending to the first part of the duodenum. Normal gastric walls.

It leaves small area of the gastric lumen and encroaching upon posterior abdominal structures, compressing the IVC and 3rd part of the duodenum decreasing SMA-Aortic angel.

Case Discussion

The mother of the patient on asking her for abnormal psychological habits admitted trichophagia. The clinician ordered ultrasound for hard abdominal mass which revealed a markedly shadowing hard lesion with normal bowel features at the lower abdominal area. The radiological features with a history strongly proposed the diagnosis of trichobezoar. In this case, it extends to the first part of the duodenum causing partial stomach outlet obstruction (Rapunzel syndrome). Surgical removal of the mass is the only proposed treatment option. Nutritional and psychological help after surgical treatment is advised.

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