PMC6000761_01
(a) Trichobezoar being extracted at first laparotomy. (b) Trichobezoar extracted by first laparotomy.
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It was diagnosed as Rapunzel syndrome as trichobezoar was extending into small intestine (Fig. 1a and b.
Barium meal image showing filling defect.
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Barium meal study revealed a large filling defect in the stomach that was suggestive of bezoars (Fig. 2).
CT scan of the abdomen demonstrated a trichobezoar in the stomach that extended into the duodenum and jejunum.
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A computed tomography (CT) scan demonstrated well defined heterogeneous, iso to hypodense cast-like mass with peripheral contrast opacification, mainly in body and pyloric region also extending to the duodenum and also in jejunum with focal dilatation of jejunal loops in left lumbar region. (Fig. 3).
(a) The trichobezoar being extracted by gastrotomy. (b) The trichobezoar being extracted by enterotomy.
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The trichobezoar mass was removed via anterior gastrotomy and enterotomy incisions (Fig. 4a and b).
Stomach shaped trichobezoar with tapering tail extending into duodenum and jejunum specimen extracted by second laparotomy.
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The total length of the trichobezoar was approximately 40 cm* 22 cm* 10 cm, with a weight of 1300 g (Fig. 5) and was a perfect cast of stomach, pylorus, duodenum and proximal jejunum.