P3427 - Entangled in the Endoscopic Management of Rapunzel Syndrome

Dexter E. Nwachukwu, DO, MS¹, Abdullah Memon, MD¹, Alexander Pan, MD², Asim Shuja, MD^1
1University of Illinois Chicago, Chicago, IL; ²University of Illinois at Chicago, Chicago, IL

Introduction: Rapunzel syndrome, a rarely encountered medical entity, presents an intricate interplay between psychological and gastrointestinal manifestations. It involves the formation and coalescence of ingested hair casts, forming a trichobezoar that can extend into the small bowel. The syndrome is named after the fairy tale character known for letting down her hair from a tower. This condition typically affects individuals with psychiatric or developmental conditions that involve ingesting large amounts of hair, a behavior known as trichophagia.

Case Description/Methods: We report a complex case of Rapunzel syndrome in a 33-year-old woman with chromosome 22 syndrome, severe intellectual disability, and multiple comorbidities, who presented to the emergency department with worsening discharge and purulent collections around her G-tube insertion. Clinical evaluation and CT imaging revealed the presence of an expanding trichobezoar, extending from the stomach into the jejunum, causing enteritis and symptoms of obstruction. The patient's deteriorating mental status and consumption of non-food items added complexity to the case. Initial attempts at endoscopic extraction were unsuccessful due to the interwoven nature of the trichobezoar. Ultimately, a robotic-assisted removal was performed by general surgery. Postoperative care included close monitoring for post-op ileus and gradual advancement of the patient's diet.

Discussion: The case highlights the need for a multidisciplinary approach involving medical, surgical, and psychiatric specialties to ensure successful management of trichobezoars in complex patients. Various endoscopic techniques have been described, including traditional endoscopic grasping for extraction and the use of soft drinks and enzymatic solutions for endoscopic fragmentation in cases involving smaller phytobezoars. Advanced techniques such as endoscopic electrohydraulic lithotripsy, argon plasma coagulation (APC), and snare electrocautery have also been employed for more complex trichobezoar cases. These approaches offer less invasive and non-surgical options, which can be further expanded as endoscopic techniques continue to evolve. This case underscores the importance of careful evaluation, tailored interventions, and ongoing psychiatric evaluation to prevent recurrence and optimize outcomes in patients with trichobezoar-associated conditions.


Disclosures:


Dexter E. Nwachukwu, DO, MS¹, Abdullah Memon, MD¹, Alexander Pan, MD², Asim Shuja, MD¹. P3427 - Entangled in the Endoscopic Management of Rapunzel Syndrome, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.