Multiple small bowel perforation in a young adult female due to Rapunzel Syndrome

Abstract

INTRODUCTION: Rapunzel’s syndrome is the state of the gastric trichobezoar (hair ball) extending to the small intestine.
Although it is seen very rarely, it is a psychiatric and mental illness especially in young women. We present here, a
young female with recurrent trichotillomania.

CASE PRESENTATION: In a 24-year-old patient who underwent laparotomy due to recurrent trichobezoar, which completely filled the stomach and extended to the small intestine, caused perforation in two places in the small intestine,
was removed by gastrotomy and enterotomy. One of the perforated areas was very close to ligament of Treitz, and perforation occurred due to the ulcer caused by trichobezoar. Post-operative central total parenteral nutrition was given and oral intake was started at the end of the first week. The patient was referred to psychiatry and antipsychotic medication was started. She was discharged on the 9th postoperative day without any problem.

CONCLUSION: Although there are no signs of peritonitis in such Rapunzel syndrome cases, a detailed exploration should
be made by keeping in mind that trichobezoar will cause ulceration and perforation. In addition, as the primary cause
is the underlying psychiatric disorder, patients should be referred to the psychiatry clinic to prevent recurrence.