A female in her twenties presents with complaints of abdominal pain, abdominal distention, and vomiting. On examination, she was found to have alopecia and crepitus in the epigastrium. What is your diagnosis?
A. Trichobezoar
B. Carcinoma pyloric antrum
C. Intestinal tuberculosis
D. Rectus sheath hematoma
Answer is A. Trichobezoar
Rapunzel’s syndrome (named after the captive maiden in the Grimm’s fairy tale) refers to severe cases of trichobezoar that extend from the stomach into the small bowel and may even reach the caecum.
Gastric bezoars may obstruct the stomach and cause gastric ulceration.
It is a hair-ball commonly seen in the stomach of females with psychiatric illness, who swallow hair regularly.
The most common presenting signs are abdominal pain, nausea and vomiting, obstruction, and peritonitis. Less commonly, patients have presented with weight loss, anorexia, hematemesis, and intussusception.
Barium outlines and often penetrates the mass, showing a filling defect in the stomach, which often has a mottled appearance.
Clinical Feature:
Epigastric pain, early satiety
Haematemesis
Features of gastritis
Loss of appetite
Perforation
Epigastric mass