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[Rapunzel syndrome: Radiological diagnosis]

[متلازمة رابونزيل: التشخيص الإشعاعي].
Authors: Yhessica Yhazmin Lara-Zavala; Inés Álvarez-Ciaca; Álvaro J. Montiel-Jarquín; Nancy R. Bertado-Ramírez; Arturo García-Galicia; Gisela Alonso-Torres;

[Rapunzel syndrome: Radiological diagnosis]

Abstract

Rapunzel syndrome is a rare presentation of trichobezoar, secondary to the ingestion of hair known as trichophagia. This bezoar has been found mainly in women, it invas the stomach and extends to the small intestin. Clinically, patients present weight loss and chronic obstructive symptoms at the intestinal level. A case of Rapunzel syndrome is presented.A 13-year-old female presented with a weight loss of 10kg in two months, chronic constipation, prédominantly nocturnal vomiting, and abdominal pain of seven days' duration. Physical examination revealed decreased peristalsis and a palpable mass in the epigastrium. Laboratories taken on admission : normal blood count, kidney function tests, and liver function tests. The abdominal X-ray showed opacity in the fundus, body and gastric antrum, the abdominal ultrasound showed non-specific findings in the epigastrium, later an abdominal tomography was performed with a swallow of water-soluble contrast medium and showed occupation in the gastric lumen. She underwent exploratory laparotomy and the finding was a trichobezoar in the stomach with extension to the duodenum and part of the jejunum, which was removed without complications. The evolution of the patient was favorable.For the diagnosis of Rapunzel Syndrome, the use of contrast imaging studies is necessary, and the treatment of choice is surgical. Le syndrome de Rapunzel est une présentation rare de tricobezoar, secondaire à la prise de cheveux connue sous le nom de trichophagie. Ce bézoar a été trouvé principalement chez les femmes, envahit l'estomac et s'étend à l'intestin grêle. Cliniquement, les patients présentent une perte de poids et des symptômes chroniques de type obstructif au niveau intestinal. Il existe un cas de syndrome de Rapunzel.patiente de 13 ans qui présente une perte de poids de 10 kg en deux mois, une constipation chronique, des vomissements nocturnes et des douleurs abdominales de sept jours d'évolution. À l'examen physique, on a trouvé un péristaltisme diminué et une masse palpable dans l'épigastre. Laboratoires prélevés à votre admission : biométrie sanguine, tests de la fonction rénale et hépatique normaux. La radiographie de l'abdomen a montré une opacité dans le fond, le corps et l'antre gastrique, l'échographie de l'abdomen a montré des résultats non spécifiques dans l'épigastre, puis une tomographie abdominale a été réalisée avec une gorgée de produit de contraste hydrosoluble et a montré une occupation de la lumière gastrique. Il a subi une laparotomie exploratrice et la découverte était un trichobézoaire dans l'estomac avec une extension au duodénum et une partie de jéjunum, il a été enlevé sans complications. L'évolution de la patiente a été favorable. Pour le diagnostic du syndrome de Rapunzel, l'utilisation d'études d'imagerie contrastées est nécessaire et le traitement de choix est chirurgical.

Rapunzel syndrome is a rare presentation of trichobezoar, secondary to the ingestion of hair known as trichophagia. This bezoar has been found mainly in women, it invades the stomach and extends to the small intestine. Clinically, patients present weight loss and chronic obstructive symptoms at the intestinal level. A case of Rapunzel syndrome is presented.A 13-year-old female presented with a weight loss of 10kg in two months, chronic constipation, predominantly nocturnal vomiting, and abdominal pain of seven days' duration. Physical examination revealed decreased peristalsis and a palpable mass in the epigastrium. Laboratories taken on admission: normal blood count, kidney function tests, and liver function tests. The abdominal X-ray showed opacity in the fundus, body and gastric antrum, the abdominal ultrasound showed non-specific findings in the epigastrium, later an abdominal tomography was performed with a swallow of water-soluble contrast medium and showed occupation in the gástric lumen. She underwent exploratory laparotomy and the finding was a trichobezoar in the stomach with extension to the duodenum and part of the jejunum, which was removed without complications. The evolution of the patient was favorable.For the diagnosis of Rapunzel Syndrome, the use of contrast imaging studies is necessariary, and the treatment of choice is surgical.el síndrome de Rapunzel es una presentación poco frecuente de tricobezoar, secundario a la ingesta de cabello conocida como tricofagia. Este bezoar se ha encontrado principalmente en mujeres, invade estómago y se extiende a intestino delgado. Clínicamente, los pacientes presentan pérdida de peso y síntomas crónicos de tipo obstructivo a nivel intestinal. Si presenta un caso de síndrome de Rapunzel.paciente mujer de 13 años que se presenta con pérdida de peso de 10 kg en dos meses, estreñimiento crónico, vómito de predominio nocturno y dolor abdominal de siete días de evolución. A la exploración física, se encontró peristalsis disminuida y masa palpable en epigastrio. Laboratorios tomados a su ingreso: biometría hemática, pruebas de función renal y hepáticas normales. La radiografía de abdomen mostró opacidad en fundus, cuerpo y antro gástrico, la ecografía de abdomen mostró hallazgos inespecíficos en epigastrio, posteriormente se realizó tomografía abdominal con trago de medio de contraste hidrosoluble y mostró ocupación en la luz gástrica. Se sometió a laparotomía exploradora y el hallazgo fue un tricobezoar en estómago con extensión a duodeno y parte de yeyuno, fue removido sin complicaciones. La evolución de la paciente fue favorable.para el diagnóstico del síndrome de Rapunzel es necesario el uso de estudios de imagen contrastados y el tratamiento de elección es quirúrgico.

Rapunzel syndrome is a rare presentation of trichobezoar, secondary to the ingestion of hair known as trichophagia. This bezoar has been found mainly in women, it invades the stomach and extends to the small intestine. Clinically, patients present weight loss and chronic obstructive symptoms at the intestinal level. A case of Rapunzel syndrome is presented.A 13-year-old female presented with a weight loss of 10kg in two months, chronic constipation, predominantly nocturnal vomiting, and abdominal pain of seven days' duration. Physical examination revealed decreased peristalsis and a palpable mass in the epigastrium. Laboratories taken on admission: normal blood count, kidney function tests, and liver function tests. The abdominal X-ray showed opacity in the fundus, body and gastric antrum, the abdominal ultrasound showed non-specific findings in the epigastrium, later an abdominal tomography was performed with a swallow of water-soluble contrast medium and showed occupation in the gastric lumen. She underwent exploratory laparotomy and the finding was a trichobezoar in the stomach with extension to the duodenum and part of the jejunum, which was removed without complications. The evolution of the patient was favorable.For the diagnosis of Rapunzel Syndrome, the use of contrast imaging studies is necessary, and the treatment of choice is surgical.el síndrome de Rapunzel es una presentación poco frecuente de tricobezoar, secundario a la ingesta de cabello conocida como tricofagia. Este bezoar se ha encontrado principalmente en mujeres, invade estómago y se extiende a intestino delgado. Clínicamente, los pacientes presentan pérdida de peso y síntomas crónicos de tipo obstructivo a nivel intestinal. Se presenta un caso de síndrome de Rapunzel.paciente mujer de 13 años que se presenta con pérdida de peso de 10 kg en dos meses, estreñimiento crónico, vómito de predominio nocturno y dolor abdominal de siete días de evolución. A la exploración física, se encontró peristalsis disminuida y masa palpable en epigastrio. Laboratorios tomados a su ingreso: biometría hemática, pruebas de función renal y hepáticas normales. La radiografía de abdomen mostró opacidad en fundus, cuerpo y antro gástrico, la ecografía de abdomen mostró hallazgos inespecíficos en epigastrio, posteriormente se realizó tomografía abdominal con trago de medio de contraste hidrosoluble y mostró ocupación en la luz gástrica. Se sometió a laparotomía exploradora y el hallazgo fue un tricobezoar en estómago con extensión a duodeno y parte de yeyuno, fue removido sin complicaciones. La evolución de la paciente fue favorable.para el diagnóstico del síndrome de Rapunzel es necesario el uso de estudios de imagen contrastados y el tratamiento de elección es quirúrgico.

Rapunzel syndrome is a rare presentation of trichobezoar, secondary to the ingestion of hair known as trichophagia. This bezoar has been found mainly in women, it invades the stomach and extends to the small intestine. Clinically, patients present weight loss and chronic obstructive symptoms at the intestinal level. A case of Rapunzel syndrome is presented.A 13-year-old female presented with a weight loss of 10kg in two months, chronic constipation, predominantly nocturnal vomiting, and abdominal pain of seven days' duration. Physical examination revealed decreased peristalsis and a palpable mass in the epigastrium. Laboratories taken on admission: normal blood count, kidney function tests, and liver function tests. The abdominal X-ray showed opacity in the fundus, body and gastric antrum, the abdominal ultrasound showed non-specific findings in the epigastrium, later an abdominal tomography was performed with a swallow of water-soluble contrast medium and showed occupation in the gastric lumen. She underwent exploratory laparotomy and the finding was a trichobezoar in the stomach with extension to the duodenum and part of the jejunum, which was removed without complications. The evolution of the patient was favorable. For the diagnosis of Rapunzel Syndrome, the use of contrast imaging studies is necessary, and the treatment of choice is surgical. Rapunzel syndrome is a rare presentation of trichobezoar, secondary to hair intake known as trichophagia. This bezoar has been found mainly in women, invades the stomach and extends to the small intestine. Clinically, patients have weight loss and chronic obstructive symptoms at the intestinal level. There is a case of Rapunzel syndrome. A 13-year-old female patient who presents with a weight loss of 10 kg in two months, chronic constipation, vomiting predominantly at night and abdominal pain for seven days. On physical examination, decreased peristalsis and palpable mass was found in the epigastrium. Laboratories taken upon admission: blood biometrics, normal kidney and liver function tests. The abdominal radiograph showed opacity in fundus, body and gastric antrum, the abdominal ultrasound showed non-specific findings in epigastrium, subsequently abdominal tomography was performed with a swallow of water-soluble contrast medium and showed occupation in the gastric lumen. He underwent exploratory laparotomy and the finding was a trichobezoar in the stomach with extension to the duodenum and part of the jejunum, it was removed without complications. The patient's progress was favorable. For the diagnosis of Rapunzel syndrome, the use of contrasted imaging studies is necessary and the treatment of choice is surgical.

متلازمة رابونزيل هي عرض نادر لبازهر الشعر، ثانوي لابتلاع الشعر المعروف باسم البلع الشعري. تم العثور على هذا البازهر بشكل رئيسي في النساء، ويغزو المعدة ويمتد إلى الأمعاء الدقيقة. من الناحية السريرية، يعاني المرضى من فقدان الوزن وأعراض الانسداد المزمن على مستوى الأمعاء. ظهرت حالة من متلازمة رابونزيل، حيث عانت أنثى تبلغ من العمر 13 عامًا من فقدان الوزن بمقدار 10 كجم في شهرين، والإمساك المزمن، والقيء الليلي في الغالب، وآلام في البطن لمدة سبعة أيام. كشف الفحص البدني عن انخفاض التمعج وكتلة ملموسة في الشرسوف. المختبرات التي تم أخذها عند القبول: تعداد الدم الطبيعي، واختبارات وظائف الكلى، واختبارات وظائف الكبد. أظهرت الأشعة السينية للبطن عتامة في قاع المعدة والجسم وغار المعدة، وأظهرت الموجات فوق الصوتية للبطن نتائج غير محددة في الشرسوفي، وفي وقت لاحق تم إجراء تصوير مقطعي للبطن مع ابتلاع وسط تباين قابل للذوبان في الماء وأظهرت احتلالًا في تجويف المعدة. خضعت لعملية شق البطن الاستكشافية وكانت النتيجة بازهرًا شعريًا في المعدة مع امتداد إلى الاثني عشر وجزء من الصائم، والذي تمت إزالته دون مضاعفات. كان تطور المريض مواتياً. لتشخيص متلازمة رابونزيل، من الضروري استخدام دراسات التصوير بالتباين، والعلاج المختار جراحي. متلازمة رابونزيل هي عرض نادر لبازهر الشعر، ثانوي لتناول الشعر المعروف باسم البلعمة الشعرية. تم العثور على هذا البازهر بشكل رئيسي في النساء، ويغزو المعدة ويمتد إلى الأمعاء الدقيقة. من الناحية السريرية، يعاني المرضى من فقدان الوزن وأعراض الانسداد المزمن على مستوى الأمعاء. هناك حالة متلازمة رابونزيل، وهي مريضة تبلغ من العمر 13 عامًا تعاني من فقدان الوزن بمقدار 10 كجم في شهرين، والإمساك المزمن، والقيء في الغالب في الليل، وآلام في البطن لمدة سبعة أيام. عند الفحص البدني، تم العثور على انخفاض التمعج والكتلة الملموسة في الشرسوف. المختبرات التي يتم أخذها عند القبول: القياسات الحيوية للدم، واختبارات وظائف الكلى والكبد الطبيعية. أظهر التصوير الشعاعي للبطن عتامة في قاع المعدة والجسم وغار المعدة، وأظهر التصوير بالموجات فوق الصوتية للبطن نتائج غير محددة في الشرسوفي، ثم تم إجراء التصوير المقطعي للبطن ببلعة من وسط التباين القابل للذوبان في الماء وأظهر احتلالًا في تجويف المعدة. خضع لعملية شق البطن الاستكشافية وكانت النتيجة بازهر شعري في المعدة مع امتداد إلى الاثني عشر وجزء من الصائم، وتمت إزالته دون مضاعفات. كان تقدم المريض إيجابيًا. لتشخيص متلازمة رابونزيل، من الضروري استخدام دراسات التصوير المتناقض والعلاج المختار جراحي.

Keywords

Adolescent, Duodenum, Vomiting, Surgical Suture Materials and Techniques, Tricotilomanía, Bezoares, Bezoars, Trichotillomania, Exploratory laparotomy, Rapunzel Syndrome, Health Sciences, Humans, Internal medicine, Laparotomy, Stomach, Gastroenterology, Syndrome, Bezoar, Síndrome de Rapunzel, Jejunum, Obstrucción Intestinal, Medicine, Female, Surgery, Etiology and Management of Peritoneal Adhesions, Gastrointestinal Bezoars, Tomography, X-Ray Computed, Hernia Repair Techniques and Materials, Intestinal Obstruction, Hair

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This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
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This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
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