Rapunzel syndrome in a seven year old female.

Rapunzel syndrome is characterized by gastric trichobezoar with extension beyond pylorus. Seven year old female presented with chronic pain abdomen and loss of appetite. Upper gastrointestinal (UGI) endoscopy showed large trichobezoar in the stomach with its tail extending into proximal duodenum. Child underwent exploratory laparotomy and a large trichobezoar measuring 15 cm was removed. Psychiatric opinion revealed that the child was suffering from `trichotillomania`; an obsessive compulsive disorder. UGI endoscopy is the preferred modality for diagnosis, as it delineates the mass and its extent. Small bezoars can be extracted via endoscopy using various disintegrating techniques but large bezoars need surgical management.

Fanconi-Bickel syndrome - mutation in SLC2A2 gene.

Fanconi-Bickel Syndrome (FBS) is a rare autosomal recessive disorder of carbohydrate metabolism. The defect in the GLUT 2 receptors in the hepatocytes, pancreas and renal tubules leads to symptoms secondary to glycogen storage, glucose metabolism and renal tubular dysfunction. Derangement in glucose metabolism is classical with fasting hypoglycemia and post-prandial hyperglycemia. The authors report a 4-year-old boy who presented with failure to thrive, motor delay, protuberant abdomen and was noted to have huge hepatomegaly with glycogen deposition in liver, and renal tubular acidosis. Gene sequencing revealed homozygous mutation, c.1330T > C in SLC2A2 gene, thus confirming the diagnosis of FBS. Only three mutations have been reported from India so far. The primary reason for referral to authors' hospital was for liver transplantation, but an accurate diagnosis led to avoidance of the major surgery and streamlining of treatment with clinical benefit to the child and family.