Small-Bowel Obstruction Secondary to a Trichobezoar in a Meckel’s Diverticulum in a Patient with Rapunzel Syndrome

  • Maarten J. OttenEmail author
  • Ayoub Charehbili
  • Lucia E. Duinhouwer
GI Image

Clinical Data

A 14-year-old girl with lower abdominal pain and intermitted vomiting with a clinical suspicion of appendicitis was seen in our emergency department with 1 week of onset of abdominal pain. Physical examination revealed diffuse tenderness to palpation in the lower abdomen and decreased bowel sounds. She had no fever. The laboratory tests revealed increased CRP of 94 mg/L (reference value, 0–10) without leukocytosis and no further abnormalities. Pregnancy test was negative. The differential diagnosis preoperatively included appendicitis, gastroenteritis, and intussusception. Ultrasound examination showed ascites and multiple dilated small-bowel loops. The appendix could not be visualized. The patient was admitted. The following day, CRP increased up to 209 mg/L (0–10). A second-look ultrasound was again inconclusive for appendicitis. Given the young age of the patient, a MRI was performed which revealed an endoluminal mass in the stomach and a small bowel obstruction. The...



C-reactive protein


Computed tomography


Author Contributions

MO wrote the manuscript and interpreted radiodiagnostics. AC assisted in interpretation of radiodiagnostics and drafting of the manuscript. LD supervised critical revision of the manuscript and contributed to clinical care. All authors discussed the results and commented on the manuscript.


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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Maarten J. Otten
    • 1
    Email author
  • Ayoub Charehbili
    • 1
  • Lucia E. Duinhouwer
    • 2
  1. 1.Department of RadiologyMaasstad ziekenhuisRotterdamThe Netherlands
  2. 2.Department of SurgeryMaasstad ziekenhuisRotterdamThe Netherlands

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