Combined Endoscopy-laparoscopy-gastrostomy extraction for rafunzel syndrome

Abstract

Introduction : Rapunzel syndrome (RS) is an uncommon diagnosis in children with less than 40 cases reported. Open - laparotomy - gastrostomy, as standard treatment, has many risks, while single endoscopy or laparoscopy is quite hard to be performed for too many trichobezoars. We present a case of RS treated success fully with the first combination of endoscopy - laparoscopy - gastrostomy. Case : A 9 - year - old girl with episodic abdominal pain, recurrent vomiting, anorexia, constipation, non - tender abdominal enlargement, trichophagia, and trichotillo mania was diagnosed as RS from barium meal and endoscopy examination. We performed combined endoscopy - laparoscopy - gastrostomy to remove 400g of bezoar mass. The patient had a good out come and a shorter hospital stay. Conclusion : Combined endoscopy - laparoscopy - gastrostomy provide better treatment of choice in a child with Rapunzel syndrome. Key messages : Minimal invasive surgery performed through combined endoscopy - laparoscopy - gastrostomy is the new removal technique for large size trichobezoar.