Trichobezoar with and without Rapunzel Syndrome in paediatri
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A bezoar is the dense mass formed by the non absorbable ingested materials in gastrointestinal tract. Based on their compositions, bezoars are classified into phytobezoars (composed of vegetables or fruit fibres), trichobezoars (balls of hair or hair-like fibres), diospyrobezoars (of persimmon), pharmacobezoar (of pills), lactobezoars (of milk and curd), lithobezoars (fragments of stones) or plasticobezoars (plastic). Rapunzel syndrome is an extremely rare variant of trichobezoar in which there is a tailed extension of this mass that reaches up to duodenum, jejunum, ileum and even up to colon. It is usually seen in children and young girls predisposed to psychiatric illness like trichotillomania (practice of pulling hair) and trichophagia (habitual ingestion of hair) or some social problem. The patients usually present with abdominal pain, nausea, vomiting, early satiety, loss of appetite and even symptoms of intestinal obstruction and peritonitis in advanced stages. It is diagnosed incidently while investigating the patient for these symptoms as the history of coexisting psychiatric illness is usually concealed by the patients and the parents. Treatment is removal of the mass either by upper gastrointestinal endoscopy, laparoscopy or by open surgery and treatment of the coexisting psychiatric illness if any. The article presents two pediatric cases of Rapunzel syndrome. They were managed successfully by open surgical intervention in view of the very large size of the mass in all the case...

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