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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
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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...

Abbreviations

CRP

C-reactive protein

CT

Computed tomography

Notes

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.

References

  1. 1.
    Grant JE, Odlaug BL. Clinical Characteristics of Trichotillomania with Trichophagia. Compr Psychiatry 2008; 49(6): 579–584CrossRefGoogle Scholar
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    Gorter RR, Kneepkens CMF, Mattens ECJL, Aronson DC, Heij HA. Management of trichobezoar: case report and literature review. Pediatr Surg Int 2010; 26:457–463CrossRefGoogle Scholar
  3. 3.
    Wang Z, Cao F, Liu D, Fang Y, Li F. The diagnosis and treatment of Rapunzel syndrome. Acta Radiol Open2016; 5:20.Google Scholar

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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