Rapunzel Syndrome Causing Appendicitis in an 8-year-old Girl
An 8-year-old girl was admitted with history of abdominal pain, nausea, bilious vomiting, weight loss, and constipation. The history was on and off for almost 1 year. She was previously treated in a primary health care center as a case of gastroenteritis and parasitic infestations. Despite treatment she was receiving, there was no improvement in her condition. Physical examination revealed tenderness in right pelvic fossa and abdominal distension. Hematologic investigations show low hemolobin (9.2 gm%) and red cells were microcytic hypochromic. Total leukocyte count was raised (15,500/mm3) and differential leukocyte count reveals neutrophilia (72%). X-ray abdomen showed multiple fluid levels. Ultrasonography reveals impression of subacute intestinal obstruction with dilated bowel loops. The patient underwent an exploratory laparotomy. A huge trichobezoar was identified, which took the shape of stomach. There was a long tail of hair extending through the pylorus into the small bowel []. By this feature diagnosis of Rapunzel syndrome was clear. By gastrotomy and enterotomy procedure, trichobezoar was dislodged and removed. Appendix was inflamed so a decision of appendicectomy was also taken along with. On histopathologic examination hair shaft was seen in the lumen of appendix leading to acute appendicitis [].