Gastrointestinal trichobezoars in the pediatric population: a retrospective study.

BACKGROUND: Trichobezoar is an extremely rare condition characterized by a foreign body in the gastrointestinal tract (GIT) among children. The foreign body may exist in the digestive tract for several years, and it becomes evident if complications develop. The current study aimed to present 21 cases of GIT trichobezoars. METHODS: Retrospective analysis of children who were diagnosed with trichobezoars between August 2012 and December 2022. Patient demographics, clinical presentation, diagnosis, and therapy were collected and analyzed.Twenty-one patients had GIT trichobezoars. Data were collected and analyzed retrospectively. RESULTS: Twenty-one patients were identified. All patients were female. Their mean age at admission was 8.9 ± 1.9 years. Furthermore, 19 (90.5%) patients presented with abdominal pain, 16 (76.2%) with vomiting, and 13 (61.9%) with a palpable mass. Sixteen patients underwent gastroduodenoscopy. Among them, 15 had gastric trichobezoars. Moreover, 12 patients underwent computed tomography scan. Eight patients presented with gastric and small intestinal BZs, one presented with increased small intestinal contents with dilation, and one presented with abundant gastric contents. Then, 20 patients underwent surgery. Among them, five underwent laparoscopic-assisted minilaparotomy (LAML), and the rest underwent laparotomy. The results showed that 10 (50%) patients had gastric trichobezoars; 7 (35%), Rapunzel syndrome; and 3 (15%), small bowel trichobezoars. Two patients developed superficial wound infection postoperatively. One patient had a recurrent gastric trichobezoar. CONCLUSION: Trichobezoar should be considered in young girls with a history of hair eating or those with hair in the vomit or feces. Timely diagnosis and aggressive treatment are the keys to reducing complications and improving prognosis. Laparoscopic-assisted minilaparotomy is a safe, feasible, and effective surgical method for treating trichobezoars.

Rapunzel syndrome in children: a retrospective review of ten cases combined with literature review in a tertiary referral center.

PURPOSE: Rapunzel syndrome is an uncommon condition in children, and its clinical features remain unclear. This study presents the largest single-center series of pediatric cases to date, with the objective of documenting the clinical characteristics and treatment approaches for children with Rapunzel syndrome. METHODS: A retrospective study was conducted in children with Rapunzel syndrome from 2019 to 2023. We recorded age, gender, symptoms, locations of bezoar, complications, and treatment options. RESULTS: Ten patients with Rapunzel syndrome were included. The median age was 9.1 years, with all of whom were female. The most common clinical symptoms were upper abdominal mass (90%), abdominal pain (80%), and nausea and vomiting (50%). Complications occurred in six cases (60%), including small bowel obstruction (20%), severe gastric dilatation (10%), intestinal perforation (10%), choledochodilation (10%), acute pancreatitis with cholecystitis (10%). Preoperative ultrasonography suggested low-echoic foreign bodies continuing to the jejunum or ileocecal region in five cases (50%). Preoperative gastroscopy attempted in four cases (40%) to remove the foreign bodies, all of which failed. All patients underwent surgical treatment, with nine cases undergoing gastric incision foreign body removal, and one case undergoing gastric incision foreign body removal combined with intestinal perforation repair. All patients recovered well. No recurrence was observed during follow-up. CONCLUSION: The accuracy of ultrasound diagnosis in identifying Rapunzel syndrome is high; however, it may lead to misdiagnosis if not complemented with the patient's medical history. Endoscopic presents a heightened treatment risk and a reduced success rate. The condition commonly presents with severe complications, thus making laparotomy a safe and effective option for intervention.

Expect the unexpected: bezoar-caused gastric perforation in the 19-year-old patient, after traffic accident.

A 19-year-old female involved in a traffic accident presented to the Emergency Room (ER) with no trauma-related symptoms but a palpable mass in the epigastrium. Imaging revealed a massive trichobezoar causing gastric perforation. Urgent laparotomy was performed, and a 1.5-kilogram bezoar was removed, along with repairing coexisting gastric ulcers. The patient had a history of trichophagia, suggesting a psychiatric association. This case highlights the potential of trichobezoars to cause gastric perforation, even in patients admitted for unrelated reasons. CT-scan proves effective in diagnosing such cases. While a traffic accident might be a plausible cause, the presence of a bezoar can elevate the risk of complications. Psychiatric evaluation is recommended when trichophagia is identified. The study underscores the need for vigilance in unexpected scenarios, demonstrating the importance of multidisciplinary approaches in managing such cases.

Ileal Trichobezoar Presenting with Acute Appendicitis and Intestinal Obstruction: A Rare Case Report and Review of Literature.

Trichobezoar is a rare diagnosis among pediatric patients highlighting underlying psychiatric illness. Gastric bezoar with a long tail extending into small bowel may present with varied presentation including small bowel obstruction. Isolated small bowel trichobezoar is rare making diagnosis difficult highlighted in the index case.

Rapunzel Syndrome: A Concealed Tale of the Misleading Tail.

The diagnosis of Rapunzel syndrome can sometimes be challenging. The silent features such as poor appetite, constipation, anemia, hypoalbuminemia, and hypoproteinemia were all overlooked in our patient initially. The Rapunzel tail leads to multiple intussusceptions and an unexpected perforation sealed by intussusceptions. Perforation sealed by intussusceptions in a clinically stable patient of Rapunzel syndrome has never been reported.

Uncommon cause of respiratory failure due to a bezoar in the hypopharynx: a case report.

BACKGROUND: Trichotillomania and trichophagia cause trichobezoars, which are masses made of hair. The main presentation of this condition is abdominal pain. However, other complications include gastric outlet obstruction, nausea, vomiting, weight loss, malnutrition, hematemesis, diarrhea, and constipation. CASE PRESENTATION: A 57-year-old woman with trichotillomania was admitted to the Emergency Department with the chief complaints of dyspnea on exertion, shortness of breath, dysphagia, generalized weakness, and hoarseness. Spiral chest computed tomography (CT) scan did not reveal any parenchymal lesions Pulmonary CT angiography did not reveal pulmonary embolism. The patient was admitted to the Surgery Department for hand fasciotomy due to contrast leakage, and during laryngoscopy, a trichobezoar was detected that was removed with Magill forceps. CONCLUSIONS: Rare cases of trichobezoars can be observed in humans with gastrointestinal and respiratory symptoms. Precise and timely diagnosis are key for the prevention of more invasive diagnostic procedures.

Sex Differences in Age at Onset and Presentation of Trichotillomania and Trichobezoar: A 120-Year Systematic Review of Cases.

Trichotillomania (hair-pulling disorder) has high female preponderance. It has been suggested that onset in early childhood represents a distinct developmental subtype that is characterized by higher prevalence of males compared to later onset cases. However, the empirical literature is scarce. We conducted a systematic review of case reports to examine the distribution of age at onset/presentation in males and females with trichotillomania or trichobezoar (a mass of hair in the gastrointestinal tract resulting from ingesting hair). We identified 1065 individuals with trichotillomania and 1248 with trichobezoar. In both samples, males, compared to females, had earlier age at presentation and greater proportion of cases in early childhood. These sex differences remained after potential confounding variables were accounted for. The results showed similar sex differences for age at onset, which was reported in 734 and 337 of the trichotillomania and trichobezoar cases, respectively. The findings may reflect neurodevelopmental underpinnings in early childhood trichotillomania.

An incidental finding of Rapunzel syndrome in a case of perforated appendix in a young girl.

A bezoar is a mass of indigestible foreign material found in the gastrointestinal tract, usually in the stomach. Trichobezoars are the second most common bezoars which are usually found in young psychiatric patients. A 15-year-old female patient presented with signs of intestinal obstruction and acute abdomen. The preoperative investigations revealed a perforated appendix, and an exploratory laparotomy was performed. Intraoperative findings showed presence of a mass of hair in the stomach along with a long tail extending into the small intestine. Postoperatively, the patient's condition worsened and she died because of complications of perforation peritonitis on day 3. Early diagnosis of Rapunzel syndrome can help in making early interventions. The prognosis of incidental detection of this condition depends on the accompanying cause.

Small intestinal enterolith in a dog presenting for a suspected gastric foreign body.

A 12-year-old Labrador Retriever presented for an acute onset of anorexia and vomiting. Abdominal ultrasound and abdominal radiographs were performed, and on the latter a large mineral opaque structure with concentric rings within the cranial abdomen was diagnosed as a gastric foreign body. Laparotomy revealed that the suspected gastric foreign body was a large enterolith within the small intestines. Enteroliths should be considered as one of the differential diagnoses for a large mineralized abdominal structure in a dog presented for gastrointestinal clinical signs.

Effects of combined use of keratinolytic enzymes and sugarcane fibre on the hairball excretion in cats.

Grooming is a natural hygienic behaviour of cats that favours the formation of hairballs. Increased fibre concentration in the diets is a strategy to minimize hairball formation, but it is not fully effective. Because cat hair is formed mostly by keratin, the addition of keratinases in the diets might be an alternative for hairball control. Thus, the objective was to evaluate the effect of the combined use of sugarcane fibre and a protease complex to reduce the hairball excretion in cats. Twenty-four adult cats were divided into four treatment groups (n = 6 per treatment) in a 2 × 2 factorial arrangement. Treatments were as follows: control diet (Control; containing low concentration of insoluble fibre, 5.34% of total dietary fibre), control diet plus enzyme (Co-e), high-fibre diet (HF; containing high amounts of insoluble fibre, 17.8% of total dietary fibre), and HF diet plus enzyme (HF-e). Proteases from Bacillus licheniformis PWD-1 were administered orally (5 mg/day) as gastro-resistant capsules. Total collection of faeces was carried out to determine the number of excreted hairballs and the coefficient of total tract apparent digestibilities (CTTAD) of the diets. Separate addition of insoluble fibre (HF; p = .5947) or enzyme complex (Co-e; p = .3633) had no effect on the hairballs excreted in the faeces. However, the combined use of insoluble fibre and enzymes (HF-e) reduced (p = .0344) the total number of hairballs excreted. The size distribution of hairballs (small, medium, or large) was not affected by treatments (p = .3763). The CTTAD of crude protein was not affected by protease addition (p = .781) but was reduced by HF and HF-e treatments. Sugarcane fibre associated to keratinolytic enzymes reduces the hairball excretion in cats. This strategy can be adopted for this purpose; however, methods for faecal hairball quantification must be improved. If you have not already completed a Copyright Transfer Agreement, please log on to Wiley Author Serivices, https://authorservices.wiley.com/bauthor/, sign-in and complete the License Agreement form".

An unusual cause of anaemia: Rapunzel syndrome, a case report.

Trichobezoars present with stomach ache and with a mass in the stomach. It's common in the young and middle-aged women having psychiatric disorder, presenting with stomach ache and existence of mass in the stomach. Although it's one of the rare causes of anaemia it should be considered when dealing with cases of chronic and unresponsive anaemia.

DISEASE AND PATHOLOGICAL CONDITIONS OF AN ENDANGERED RODENT, MICROTUS CALIFORNICUS SCIRPENSIS, IN A CAPTIVE-REARING FACILITY AND IN THE WILD.

Causes of morbidity and mortality and a survey of infectious disease agents were collated from wild and colony-raised endangered Amargosa voles (Microtus californicus scirpensis). Six voles from the wild and 295 voles in the captive-breeding colony were included in the study upon identification of an infectious agent during screening, identification of clinical signs of disease, or finding a pathological condition or infectious agent on necropsy. Findings included 28 significant or incidental pathological conditions of seven organ systems and 19 parasitic, viral, bacterial, or fungal agents. Several voles captured in the wild had fungal osteomyelitis of the tail that disseminated systemically in a vole brought from the wild to the colony and may have been caused by a Penicillium sp. Three voles reintroduced from the colony to the wild experienced inanition and subsequent severe hepatic and moderate renal tubular lipidosis. The most common significant pathological conditions in colony-reared voles were chronic interstitial nephritis with proteinosis; cardiomyopathy; trichobezoars that, in intestines or cecocolic junctions, sometimes induced local rupture or infarction with peritonitis; multifocal gastrointestinal ulceration and colibacillosis; acute renal tubular necrosis or nephritis; sepsis; hepatic and renal lipidosis; molar apical elongation sometimes progressing to invasion of the calvarium; and mammary tumors. Uncommon diagnoses included intervertebral disc disease; microvascular dysplasia; and multifocal bacterial abscessation. Common or clinically important infectious agents included Demodex sp. mites in hair follicles, Demodex sp. in esophageal mucosa, and an outbreak of tropical rat mites thought to have been introduced via the straw bedding; gastrointestinal Helicobacter sp.; attaching and effacing Escherichia coli; and Citrobacter braakii, a possible zoonotic bacterium. This survey of species-specific diseases and pathogens was possible because the established health surveillance program that is part of the species recovery plan allowed for monitoring of voles throughout the duration of their natural life spans in captivity.

Rapunzel Syndrome in a 3-Year-Old Boy: A Menace too Early to Present.

Rapunzel syndrome is a rare type of trichobezoar with an extension of the hair into the small bowel. Clinical presentation is deceptive and vague, ranging from asymptomatic abdominal mass to gastrointestinal perforation. There are only few cases reported in literature, with the youngest age being 3 years. We present the case of a 3-year-old male child presenting with Rapunzel syndrome and features of subacute intestinal obstruction.

Rapunzel syndrome: an infrequent cause of severe iron deficiency anemia and abdominal pain presenting to the pediatric emergency department.

BACKGROUND: Iron deficiency anemia (IDA) and abdominal pain are commonly seen in a pediatric emergency department (8 and 18% incidence respectively in our center). They are manifestations of a wide variety of diseases ranging from benign to immediately life-threatening. Trichobezoar is an under-diagnosed entity that has to be considered in children and adolescents, expecially female, suffering from trichotillomania (compulsion to pull hair) and trichophagy (compulsion to swallow hair). When undiagnosed, gastric bezoars may cause gastric ulceration, perforation, haemorrhage and obstruction. CASE PRESENTATION: To underline the importance of including this pathology in the differential diagnosis of IDA and abdominal pain, we present the case of a 14 year-old girl with a huge trichobezoar which completely filled the stomach and extended into the small bowel. Since trichobezoar has an extension to the small bowel, it is classified as Rapunzel syndrome. As the bezoar couldn't be removed by endoscopy, the girl underwent surgical intervention. The patient passed through a gradual re-feeding, with iron and vitamins supplementation, and through a psychiatric counselling. CONCLUSION: The Rapunzel syndrome is a rare entity that may be complicated by life-threatening events. A prompt diagnosis and an appropriate therapy can reduce comorbidities. Gradual re-feeding with supplementation of micronutrients allows adequate catch-up weight with normalization of haematochemical nutritional parameters. Since many of these patients suffer from psychiatric pathology such as PICA with emotional problems and mental retardation, psychological/psychiatric counselling plays an important role in order to prevent bezoar recurrence.

Beet pulp intake and hairball faecal excretion in mixed-breed shorthaired cats.

Hairball formation may induce vomiting and intestinal obstruction in predisposed cats. Some insoluble fibres as sugarcane fibre and cellulose can prevent hairball formation. The aim of this study was to evaluate the effect of beet pulp consumption, a moderate soluble and fermentable fibre source, on faecal trichobezoars excretion in adult shorthaired cats fed kibble diets. Eighteen mixed-breed shorthaired cats and three extruded diets were used as follows: a basal diet without added fibre source (PB0-8.8% dietary fibre); BP8-8% inclusion of beet pulp (17.5% of dietary fibre); BP16-16% inclusion of beet pulp (23.8% of dietary fibre). The cats were fed during 31 days and faeces quantitatively collected during three periods of 3 days each (from days 3-5; 15-17; 26-28). Gastrointestinal transit time was determined in the last 3 days of study (from days 29-31). The trichobezoars were separated from faeces, collected, dried and washed in ether for complete removal of all faecal material. The results were submitted to repeated-measure analysis of variance and means evaluated by polynomial contrast (p < 0.05). Beet pulp increased faecal production (p < 0.001) and reduced gastrointestinal transit time (p = 0.003). No alterations were found on trichobezoar faecal excretion, both as considered in number per cat per day of mg per cat per day (p > 0.05). Beet pulp intake did not reduce the number or the size of hairballs eliminated via faeces of shorthaired cats.

A rare variant of rapunzel syndrome-acute small bowel obstruction caused by ball of hairs in distal ileum with its tail extending in caecum and ascending colon.

Rapunzel syndrome is an extremely rare variant of Trichobezoar. Trichobezoar commonly occurs in patients with psychiatric disturbances as trichophagia (morbid habit of chewing the hair) and Trichotillomania (habit of hair pulling). Bezoars are commonly found in the stomach. In very rare cases of Rapunzel syndrome, hair extends through the pylorus into the small bowel and very uncommonly in large intestine causing symptoms and signs of partial or complete intestinal obstruction. A case report of a rare variant of Rapunzel syndrome, where ball of hairs in small bowel with its tail extending in caecum and ascending colon causing acute small bowel obstruction, is reported in a 13-year-old girl.

Complete laparoscopic removal of a gastric trichobezoar.

Trichobezoars are seen usually in adolescent girls and laparotomy is required to remove them, though recently laparoscopic assisted and laparoscopic removal have been reported in adults and older children. We report this 4-year-old boy who underwent complete laparoscopic removal of a gastric trichobezoar, both for its rarity in such young boys and also because he is the youngest reported patient to undergo complete laparoscopic removal of a gastric trichobezoar.

Small-bowel trichobezoars with intestinal obstruction in children: three case reports and literature review.

Trichobezoars are conglomerates of hair within the gastro-intestinal tract, commonly detected in the stomach, and they can present with the Rapunzel syndrome. Isolated small-bowel trichobezoars are extremely rare. Three female patients presented with abdominal pain and bilious vomiting, and underwent various imaging examinations. Two were diagnosed with small-bowel trichobezoars with intestinal obstruction and one with intestinal obstruction only. All three underwent surgery. Two underwent laparoscopic exploration and one underwent a laparotomy. One and two patients had isolated small-bowel trichobezoars in the ileum and jejunum, respectively. Two patients were followed up by a psychiatrist, and all recovered well without recurrence. These three cases emphasise the importance of a comprehensive medical history and imaging in patients with small-bowel obstruction to determine the possibility of bezoars.