Rapunzel syndrome refers to the condition of trichobezoar-induced intestinal obstruction. This syndrome is rare and was first reported in 1812 by Jacob and Grimm in a young girl named Rapunzel, after whom the syndrome was named. Cases of gastrointestinal trichobezoars have also been reported in China.

bubble_chart Etiology

Many individuals with pica or psychiatric disorders enjoy chewing and swallowing hair, silk threads, and similar long-fiber materials. Once ingested, these substances cannot be digested by the body. Under the mechanical force of gastric peristalsis, they become entangled and form bezoars. As gastric contents move toward the small intestine, the tail end of the bezoar may pass through the pylorus into the jejunum. Due to the tight entanglement of fibrous materials, the bezoar may struggle to advance further, gradually enlarging in the stomach and upper jejunum, leading to high intestinal obstruction or pyloric obstruction. The bezoar often compresses the mesenteric side of the small intestine wall, causing necrosis or even perforation. Occasionally, the tail end of the bezoar may extend into the ileum or large intestine.

bubble_chart Clinical Manifestations

Mostly seen in females, particularly adolescents, presenting with upper abdominal pain, abdominal distension and fullness, nausea, and vomiting. Due to the ball-valve effect of the bezoar, the vomiting volume is generally small, and the vomitus may contain bile. However, if the obstruction is at the pylorus, the vomitus does not contain bile. A few cases may be accompanied by diarrhea and gastrointestinal bleeding. Physical examination often reveals a palpable mass in the upper abdomen. If perforation occurs due to necrosis of the gastrointestinal wall, symptoms and signs of diffuse peritonitis may be present.

1. Have a history of pica or swallowing large amounts of hair, threads, etc.

2. Present with symptoms of pyloric obstruction or high small intestine obstruction.

3. A mass can be palpated in the upper abdomen; gastroscopy and X-ray examination should be performed to rule out tumors and confirm the presence of a bezoar.

bubble_chart Treatment Measures

This condition requires surgical treatment. Due to the large size of the bezoar, stone extraction is generally difficult and often necessitates multiple incisions. If intestinal necrosis is present, bowel resection should be performed.