PMC4428316_01
Female patient, aged 15 - standing X-ray of the abdomen: a soft tissue opacity mass in the mesogastrium and the right epigastrium overlapped by the colon.
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The examination revealed a large, soft tissue opacity within the mesogastrium and left epigastrium overlapped by the colon (Figure 1).
Female patient, aged 15 - intraoperative photographs: giant stomach filled with a bezoar (A); the removed huge trichobezoar reflecting the shape of the stomach (B).
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The examination was followed by surgical resection of the trichobezoar sized 30x15x7 cm (Figure 2).
PMC4428316_02
Female patient, aged 16 - preoperative photograph: a huge mass on the left side of the abdomen, bulging into the abdominal wall.
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Physical examination revealed a tumor sized ca. 35x20 cm on the left side of the abdomen (Figure 3).
Female patient, aged 16 - standing (A) and supine (B) X-ray of the abdomen: a non-homogeneous, soft tissue opacity mass with two air-fluid levels, most probably at the stomach bottom and prepyloric region as well as several short air-fluid levels in the right hypogastrium.
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Abdominal radiography revealed an opacity within the mid-abdominal region with a non-homogeneous, soft tissue opacity mass in the projection of the stomach with two air-fluid levels, most probably at the stomach bottom and prepyloric region as well as several short air-fluid levels within the projection of the right wing of ilium (Figure 4).
Female patient, aged 16 - coronal (A) and sagittal (B) reformatted CT of the abdomen after intravenous contrast administration: a giant stomach extending from the diaphragm to the hypogastrium with non-homogeneous, non-enhancing content.
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A CT was performed following intravenous contrast administration to reveal a large quantity of non-homogeneous content filling a significantly enlarged and extended stomach, extending along duodenum down to the proximal segment of jejunum (Figures 5, 6).
Female patient, aged 16 - transverse CT scan of the abdomen after intravenous contrast administration: giant stomach bulging the outline of the anterior wall of the abdomen, with non-homogeneous, not-enhancing content; distally behind the stomach, the bezoar reaches further down into the small intestine.
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A CT was performed following intravenous contrast administration to reveal a large quantity of non-homogeneous content filling a significantly enlarged and extended stomach, extending along duodenum down to the proximal segment of jejunum (Figures 5, 6).
Female patient, aged 16 - the removed trichobezoar, shape reflecting the shape of the stomach and duodenum, with tail extending into the jejunum - Rapunzel syndrome.
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A giant bezoar weighing 3 kg extending to the small intestine (Rapunzel syndrome) was resected during the surgery (Figure 7).
PMC4428316_03
Female patient aged 13 - invisible gas in the stomach in the pilot sequence of CT (A); a mixture of hair and hyperdense plaster in native scans (B, C); coronal reformatted CT scan after intravenous injection of the contrast medium - stretched stomach containing a non-enhancing mass separated from the stomach wall (D).
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Of note were numerous hyperdense elements within and along the outline of the mass (Figure 8).
Female patient, aged 13 - intraoperative photograph: a huge trichobezoar with white plaster elements filling the stomach.
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The patient was also subjected to surgery (Figure 9) and put under psychiatric care.