Case report
https://doi.org/10.21860/medflum2021_365351
Rapunzel syndrome – a rare cause of acute pancreatitis: case report
Lucija Matko
orcid.org/0000-0002-7844-9612
; Medicinski fakultet, Sveučilište u Rijeci, Rijeka, Hrvatska
Ana Bosak Veršić
; Klinika za dječju kirurgiju, KBC Rijeka, Rijeka, Hrvatska
Harry Nikolić
; Klinika za dječju kirurgiju, KBC Rijeka, Rijeka, Hrvatska
Kristina Baraba Dekanić
; Klinika za pedijatriju, KBC Rijeka, Rijeka, Hrvatska
Goran Palčevski
; Klinika za pedijatriju, KBC Rijeka, Rijeka, Hrvatska
Abstract
Aim: To raise awareness about the existence of Rapunzel syndrome in female adolescents with acute pancreatitis. Case report: A 15-year-old girl came to the emergency pediatric clinic due to the occasional pain in the upper abdomen, which had intensified a few days before her arrival. During physical examination, a painful resistance of approximately 10 cm in diameter was palpated in the epigastrium and the right hypochondrium. Extensive laboratory analysis revealed raised concentrations of pancreatic enzymes so a diagnosis of acute pancreatitis was made. Further examination indicated gastroscopy, which showed a mass of hair at the entrance to the stomach. Computed tomography revealed that the mass reached all the way to the duodenal bulbus. After the conservative treatment of pancreatitis, the abdominal pain regresses and the pancreatic enzymes returned to normal so the operative treatment was indicated. Exploratory laparotomy and gastrotomy were performed. A kilogram heavy and 25 cm long trichobezoar in the shape of the gastric lumen and the initial part of the duodenum were exploited. Rapunzel syndrome was diagnosed. The child psychiatrist confirmed the presence of trichotillomania and trichophagia, so the girl was referred to the psychotherapy treatment. Conclusion: Rapunzel syndrome is a very rare condition but should be included in the differential diagnosis of acute pancreatitis in adolescents. Specific symptoms of trichotillomania and trichophagia in combination with non-specific symptoms such as prolonged abdominal pain should raise the suspicion of the development of trichobezoars.
Keywords
adolescents; pancreatitis; Rapunzel syndrome; trichobezoar; trichotillomania
Hrčak ID:
251278
URI
Publication date:
1.3.2021.
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