Trichobezoar masquerading as massive splenomegaly: Rapunzel's syndrome revisited

[摘要] Trichobezoars are usually formed due to ingestion of hair or hair-like fibres and present with a wide spectrum of clinical manifestations. We report a case of Rapunzel's syndrome associated with trichotillomania in a 16-year-old girl who presented to our Haematology unit with complaints of fatigue, abdominal distention, and early satiety. Initial evaluation demonstrated anaemia, thrombocytosis , and a left hypochondrial mass suggestive of splenomegaly . However, ultrasound of the abdomen showed no hepatosplenomegaly and blood investigations were not suggestive of haematological malignancy . Not long after, the patient presented to the emergency department with suspected acute abdomen . Computed tomography of the abdomen revealed intraluminal gastric and jejunal masses causing small bowel obstruction . Emergency laparotomy confirmed gastric and jejunal trichobezoars, and subsequent psychiatric evaluation confirmed trichotillomania. Clinicians should consider trichobezoar in the differential diagnosis of abdominal pain and a non-tender ‘spleen-like’ abdominal mass .

[学科分类] 生物化学工程

[关键词] Trichobezoar;Splenomegaly;Trichotillomania;Rapunzel's syndrome;Anaemia