2026 Volume 42 Issue 1 Pages 76-82
A 4-year-old girl with a history of trichotillomania and trichophagia presented with recurrent abdominal pain. Abdominal ultrasonography revealed a partial twinkling artifact (TA) in the stomach. Rapunzel syndrome with trichobezoar in the stomach was diagnosed, and surgery was performed, during which additional trichobezoars were found in the duodenum and small intestine. All were removed. There has been no recurrence after her hair was shortened.
TA is associated with coarse-surfaced, highly reflective objects that cause irregular reflection or scattering of ultrasound waves, resulting in time and phase shifts that are misinterpreted by color Doppler devices as velocity. This phenomenon is useful for diagnosis of stones or calcifications. It is of note that a partial TA was observed in this case. Therefore, a phantom experiment using sewing thread as a hair substitute was conducted, and this successfully reproduced the partial TA.
Based on the above, TA on ultrasonography of the upper abdomen may be a finding suggestive of gastrolithiasis, while partial TA suggests hair gastroliths. These findings can help clinicians determine the appropriate treatment in such cases.
