Rapunzel Syndrome Removed with Enteroscopy in a Child

Sang Woo Chun; Kunsong Lee; Youn Joon Park; Hyun Deok Shin

doi:10.4166/kjg.2019.74.1.42

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Chun, Lee, Park, and Shin: Rapunzel Syndrome Removed with Enteroscopy in a Child

Case Report

The Korean Journal of Gastroenterology 2019; 74(1): 42-45.

Published online: 26 July 2019

DOI: https://doi.org/10.4166/kjg.2019.74.1.42

Rapunzel Syndrome Removed with Enteroscopy in a Child

Sang Woo Chun, Kunsong Lee

, Youn Joon Park¹, Hyun Deok Shin²

Department of Pediatrics, Dankook University College of Medicine, Cheonan, Korea.

¹Department of Pediatric Surgery, Dankook University College of Medicine, Cheonan, Korea.

²Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.

Correspondence to: Kunsong Lee, Department of Pediatrics, Dankook University College of Medicine, 201 Manghyang-ro, Dongnam-gu, Cheonan 31116, Korea. Tel: +82-41-550-3968, Fax: +82-41-550-3949, pdlks@dankook.ac.kr

Received 11 March 2019 Revised 21 April 2019 Accepted 29 April 2019

Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A trichobezoar is a type of bezoar that is composed of hair. In most cases, it is confined to the stomach, but in rare cases, it may extend to the small intestine. This condition is referred to as Rapunzel syndrome. The therapeutic method for bezoar removal depends on its type, location, and size. Generally, the treatment for Rapunzel syndrome involves surgical laparotomy. Endoscopic removal has also been effective in some cases. On the other hand, complications, such as respiratory difficulty and esophageal impaction may be encountered during endoscopic removal. Until now, the successful endoscopic removal of trichobezoars has been limited to the stomach or duodenum. This paper reports the case of a 4-year-old female patient with Rapunzel syndrome whose trichobezoar reached the proximal jejunum. The trichobezoar was removed without complications using an electrosurgical knife and snare through a single-balloon enteroscopy. The trichobezoar can be removed successfully using enteroscopy under general anesthesia without abdominal laparotomy in young children. Therefore, this method of removal can be considered preferentially for children with Rapunzel syndrome.

Keywords: Bezoars, Single-balloon enteroscopy, Child

Figures and Tables

Fig. 1

Abdomen computed tomography scan pictures of (A) and (B) show that the bezoar-like materials are found in the stomach and jejunum (yellow arrows) with mucosal thickening.

Fig. 2

Endoscopic findings. (A) The picture shows the trichobezoar passing through the pylorus in the stomach. (B) The picture shows the trichobezoar pressing the mucosa of the proximal jejunum.

Fig. 3

Endoscopic procedure and removed trichobezoar. (A) The process of cutting the trichobezoar with an ITknife2 electrosurgical knife in the stomach. (B) The trichobezoar is removed using a snare in the stomach. (C) The removed trichobezoar pieces.

Notes

^{Financial support} None.

^{Conflict of interest} None.

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ORCID iDs: Kunsong Lee
https://orcid.org/0000-0001-7318-2296
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