Combined endoscopylaparoscopy- gastronomy extraction for rapunzel syndrome

Abstract

Introduction : Ra pun zel syn drome (RS) is an un com mon di ag no sis in chil dren with less than 40 cases re ported. Open - laparotomy - gastrostomy, as stan dard treat ment, has many risks, while sin gle en doscopy or la paroscopy is quite hard to be per formed for too many tri chobe zoars. We pre sent a case of RS treated suc cess fully with the first com bi na tion of en doscopy - laparoscopy - gastrostomy. Case : A 9 - year - old girl with episodic ab dom i nal pain, re cur rent vom it ing, anorexia, con sti pa tion, non - tender ab dom i nal en large ment, tri chopha gia, and tri chotil lo ma nia was di ag nosed as RS from bar ium meal and en - doscopy ex am i na tion. We per formed com bined en doscopy - laparoscopy - gastrostomy to re move 400 g of be zoar mass. The pa tient had a good out come and a shorter hos pi tal stay. Conclusion : Com bined en doscopy - laparoscopy - gastrostomy pro vide bet ter treat ment of choice in a child with Ra pun zel syn drome. Key messages : Min i mal in va sive surgery per formed through com bined en doscopy - laparoscopy - gastrostomy is the new re moval tech nique for large size tri chobe zoar.