Case SeriesTrichobezoar with and without Rapunzel syndrome in paediatric population: A case series from a tertiary care centre of Northern India

- Trichobezoar leading to Rapunzel syndrome is an extremely rare entity.
- The clinical presentation is usually vague and non-specific but psychiatric illness is the usual association.
- Treatment is mainly surgical because of delayed presentation in majority of the cases.
- Treatment should focus on prevention of recurrence, apart from removal of the mass.
- So, in addition to the acute surgical treatment, parental counselling, neuropsychiatric treatment, follow-up and behavioural therapy of the patient should be continued to prevent recurrence.

IntroductionTrichobezoars are concretions formed by accumulation of hair in stomach. Usually, trichobezoar is confined to the stomach, but rarely it may extend from the stomach to the small intestine and even colon. This is an unusual form called Rapunzel syndrome. Our experience with this rare entity of Rapunzel syndrome and interesting entity of trichobezoar is being presented with review of literature.Presentation of casesWe, at our institute, encountered four cases of trichobezoar in last five years, out of which two were found to be of Rapunzel syndrome. All of these cases were managed successfully by open surgical intervention in view of the very large size of the mass in all the cases.DiscussionThe clinical presentation is highly variable ranging from asymptomatic cases diagnosed incidently to serious gastrointestinal symptoms and complications. Cases of trichobezoar have been reported in literature very infrequently but Rapunzel syndrome is extremely rare and less than 50 cases have been reported in medical literature till date.ConclusionTrichobezoar leading to Rapunzel syndrome is an extremely rare entity. The clinical presentation is usually vague and non-specific. Treatment is mainly surgical because of delayed presentation in majority of the cases. Psychiatric illness is the usual association.