Trichobezoar masquerading as massive splenomegaly: Rapunzel’s syndrome revisited

Trichobezoars are usually formed due to ingestion of hair or hair-like fibres and present with a wide spectrum of clinical manifestations. We report a case of Rapunzel’s syndrome associated with trichotillomania in a 16-year-old girl who presented to our Haematology unit with complaints of fatigue, abdominal distention, and early satiety. Initial evaluation demonstrated anaemia, thrombocytosis, and a left hypochondrial mass suggestive of splenomegaly. However, ultrasound of the abdomen showed no hepatosplenomegaly and blood investigations were not suggestive of haematological malignancy. Not long after, the patient presented to the emergency department with suspected acute abdomen. Computed tomography of the abdomen revealed intraluminal gastric and jejunal masses causing small bowel obstruction. Emergency laparotomy confirmed gastric and jejunal trichobezoars, and subsequent psychiatric evaluation confirmed trichotillomania. Clinicians should consider trichobezoar in the differential diagnosis of abdominal pain and a non-tender ‘spleen-like’ abdominal mass

Laparoscopic versus open repair of perforated peptic ulcer: Improving outcomes utilizing a standardized technique

Background/Objective: The objective of this study was to compare the outcomes of patients who underwent laparoscopic and open repair of perforated peptic ulcers (PPUs) at our institution. Methods: This is a retrospective review of a prospectively collected database of patients who underwent emergency laparoscopic or open repair for PPU between December 2010 and February 2014. Results: A total of 131 patients underwent emergency repair for PPU (laparoscopic repair, n = 63, 48.1% vs. open repair, n = 68, 51.9%). There were no significant differences in baseline characteristics between both groups in terms of age (p = 0.434), gender (p = 0.305), body mass index (p = 0.180), and presence of comorbidities (p = 0.214). Both groups were also comparable in their American Society of Anesthesiologists (ASA) scores (p = 0.769), Boey scores 0/1 (p = 0.311), Mannheim Peritonitis Index > 27 (p = 0.528), shock on admission (p  24 hours (p = 0.857). There was no significant difference in the operating time between the two groups (p = 0.618). Overall, the laparoscopic group had fewer complications compared with the open group (14.3% vs. 36.8%, p = 0.005). When reviewing specific complications, only the incidence of surgical site infection was statistically significant (laparoscopic 0.0% vs. open 13.2%, p = 0.003). The other parameters were not statistically significant. The laparoscopic group did have a significantly shorter mean postoperative stay (p = 0.008) and lower pain scores in the immediate postoperative period (p < 0.05). Mortality was similar in both groups (open, 1.6% vs. laparoscopic, 2.9%, p < 0.99). Conclusion: Laparoscopic repair resulted in reduced wound infection rates, shorter hospitalization, and reduced postoperative pain. Our single institution series and standardized technique demonstrated lower morbidity rates in the laparoscopic group

Laparoscopic versus open repair of perforated peptic ulcer: Improving outcomes utilizing a standardized technique

Background/Objective: The objective of this study was to compare the outcomes of patients who underwent laparoscopic and open repair of perforated peptic ulcers (PPUs) at our institution. Methods: This is a retrospective review of a prospectively collected database of patients who underwent emergency laparoscopic or open repair for PPU between December 2010 and February 2014. Results: A total of 131 patients underwent emergency repair for PPU (laparoscopic repair, n = 63, 48.1% vs. open repair, n = 68, 51.9%). There were no significant differences in baseline characteristics between both groups in terms of age (p = 0.434), gender (p = 0.305), body mass index (p = 0.180), and presence of comorbidities (p = 0.214). Both groups were also comparable in their American Society of Anesthesiologists (ASA) scores (p = 0.769), Boey scores 0/1 (p = 0.311), Mannheim Peritonitis Index > 27 (p = 0.528), shock on admission (p 24 hours (p = 0.857). There was no significant difference in the operating time between the two groups (p = 0.618). Overall, the laparoscopic group had fewer complications compared with the open group (14.3% vs. 36.8%, p = 0.005). When reviewing specific complications, only the incidence of surgical site infection was statistically significant (laparoscopic 0.0% vs. open 13.2%, p = 0.003). The other parameters were not statistically significant. The laparoscopic group did have a significantly shorter mean postoperative stay (p = 0.008) and lower pain scores in the immediate postoperative period (p < 0.05). Mortality was similar in both groups (open, 1.6% vs. laparoscopic, 2.9%, p < 0.99). Conclusion: Laparoscopic repair resulted in reduced wound infection rates, shorter hospitalization, and reduced postoperative pain. Our single institution series and standardized technique demonstrated lower morbidity rates in the laparoscopic group. © 201