Paediatric Surgery (Ukraine). 2024. 4(85): 143-147. doi: 10.15574/PS.2024.4(85).143147
Shulhai O. M.¹, Dzhyvak V. G.¹, Hoshchynskyi P. V.¹, Makivka R. I.², Krycky I. O.^1
1I. Horbachevsky Ternopil National Medical University, Ukraine
²Communal non-profit enterprise “Ternopil Regional Children’s Clinical Hospital” of the Ternopil Regional Council, Ukraine

For citation: Shulhai OM, Dzhyvak VG, Hoshchynskyi PV, Makivka RI, Krycky IO. (2024). Rapunzel syndrome in an adolescent child: clinical case. Paediatric Surgery (Ukraine). 4(85): 143-147. doi: 10.15574/PS.2024.4(85).143147.
Article received: Aug 19, 2024. Accepted for publication: Dec 10, 2024.

Gastrointestinal bezoars in children are a rather rare pathology. Rapunzel syndrome is characterized by a large trichobezoar in the stomach with a tail that extends beyond the pylorus into the small intestine, causing mechanical obstruction of the small intestine. Some cases of bezoars remain undiagnosed for a long time, since complaints or objective changes are nonspecific.
Aim– to raise awareness of Rapunzel syndrome as a rare pathology of the digestive system in children.
Clinical case. The analysis of a retrospective clinical review of one case of surgical intervention for a large gastric bezoar. The patient's gender and age, composition and size of the bezoar, clinical, laboratory and instrumental changes, surgical tactics and scope of intervention were analyzed. The problem of diagnosing and treating rare diseases of the digestive tract remains relevant. The medical record of a 14-year-old teenager with Rapunzel syndrome was analyzed. Symptoms of the pathology were lack of appetite, abdominal pain, nausea, vomiting, weight loss, bad breath, and an objective examination of the abdomen revealed the formation of a dense consistency. After surgical treatment, the patient recovered without complications.
Conclusions. Rapunzel syndrome is a rare cause of digestive symptoms in children, such as abdominal pain, anorexia, or weight loss. Raising awareness of the risk factors for this condition is crucial for early diagnosis.
The research was carried out in accordance with the principles of the Declaration of Helsinki. Parents' informed consent was obtained for children's participation in the study.
The authors declare no conflict of interest.
Keywords: children, bezoars, Rapunzel syndrome, surgical treatment.

REFERENCES

1. Al-Osail EM, Zakary NY, Abdelhadi Y. (2018). Best management modality of trichobezoar: A case report. Int J Surg Case Rep. 53: 458-460. https://doi.org/10.1016/j.ijscr.2018.11.030; PMid:30567068 PMCid:PMC6275210

2. Elghazeery MA, Hassan AM. (2024). Gastrointestinal Bezoars in Paediatrics: Case Series and Literature Review. Afr J Paediatr Surg. 21(2): 101-106. https://doi.org/10.4103/ajps.ajps_104_22; PMid:38546247 PMCid:PMC11003570

3. Kumar M, Maletha M, Bhuddi S, Kumari R. (2020). Rapunzel Syndrome in a 3-Year-Old Boy: A Menace too Early to Present. J Indian Assoc Pediatr Surg. 25(2): 112-114. https://doi.org/10.4103/jiaps.JIAPS_1_19; PMid:32139992 PMCid:PMC7020672

4. Kwon HJ, Park J. (2023). Treatment of large gastric trichobezoar in children: Two case reports and literature review. Medicine (Baltimore). 102(16): e33589. https://doi.org/10.1097/MD.0000000000033589; PMid:37083802 PMCid:PMC10118359

5. Nettikadan A, Ravi MJ, Shivaprasad M. (2018). Recurrent Rapunzel syndrome – A rare tale of a hairy tail. Int J Surg Case Rep. 45: 83-86. https://doi.org/10.1016/j.ijscr.2018.03.017; PMid:29587201 PMCid:PMC6000761

6. Nour I, AbdAlatef M, Megahed A, Yahia S, Wahba Y, Shabaan AE. (2019). Rapunzel syndrome (gastric trichobezoar), a rare presentation with generalised oedema: case report and review of the literature. Paediatr Int Child Health. 39(1): 76-78. https://doi.org/10.1080/20469047.2017.1389809; PMid:29057712

7. Paschos KA, Chatzigeorgiadis A. (2019). Pathophysiological and clinical aspects of the diagnosis and treatment of bezoars. Ann Gastroenterol. 32(3): 224-232. https://doi.org/10.20524/aog.2019.0370

8. Sinha AK, Vaghela MM, Kumar B, Kumar P. (2017). Pediatric gastric trichobezoars with acute life threatening and undifferentiated elective bipolar clinical presentations Journal of Pediatric Surgery Case Reports. 16: 5-7. https://doi.org/10.1016/j.epsc.2016.10.009

9. Sivasubramanian BP, Ashokkumar M, Afzal M, SamalaVenkata V, Dhanasekaran UD, Palit SR et al. (2022,Oct 6). Rapunzel Syndrome in a Teenage Girl: A Case Report. Cureus. 14(10): e29975. https://doi.org/10.7759/cureus.29975

10. Wang L, Chen Y, Chen S, Gao Z, Qian Y, Chen Q. (2024). Gastrointestinal trichobezoars in the pediatric population: a retrospective study. BMC Pediatr. 24(1): 124. https://doi.org/10.1186/s12887-023-04489-x; PMid:38365624 PMCid:PMC10870568