A Laparoscopically Operated Case of Rapunzel Syndrome Presented with Intussusception

Abstract

Trichobezoars, which are comparatively rare in Japan, are bezoars composed primarily of hairs which have been orally ingested due to some disease like cibophobia and are solidified in the stomach. Among of them, Rapunzel syndrome is extremely rare where parts of the huge trichobezoar extend like streaks to reach at the small intestine. We here present a case of intussusception led by a hair mass in the small intestine due to Rapunzel syndrome. The case involved a 9-year-old girl, who presented to our emergency clinic because of abdominal pain after a meal. She underwent single incision laparoscopic surgery (SILS) with a suspicion of intussusception. During surgery, we identified intussusception in the jejunum 40 cm apart from the ligament of Treitz and reduced it via the Hutchinson procedure. We found a hard mass in the bowel lumen and incision of the bowel wall disclosed the hair mass continuing from the stomach to the jejunum. The mass was impossible to be removed by using esophagogastroduodenoscopy, so that we incised the gastric wall to remove the huge trichobezoar. Her postoperative course was uneventful.