Rapunzel Syndrome: a rare cause of acute small bowel obstruction

The Rapunzel syndrome is a very rare condition where trichobezoar hasextended up to the small bowel. Here we are reporting a rare case of Rapunzel syndrome in an adolescent girl with history of trichophagia who presented with small bowel obstruction. Patient underwent exploratory laparotomy and bezoar was removed through gastrotomy. Post-operative course was unremarkable.KEY WORDS: Rapunzel syndrome; Trichobezoars; Psychotherapy; Gastrotom

Clinical and laboratory features of intestinal tuberculosis

Bhumit Patel,1 Vipul D Yagnik2 1Department of Medical Gastroenterology, Akshar Bhoomi Liver and Gastro Care, Ahmedabad, Gujarat, India; 2Department of Surgical Gastroenterology, Ronak Endo-laparoscopy and General Surgical Hospital, Patan, Gujarat, India Background/aims: As increasing numbers of Crohn’s disease (CD) cases are being recognized in India, so the differential diagnosis of CD and gastrointestinal tuberculosis (GITB) is becoming increasingly important. If patients are misdiagnosed with GITB, toxicity may result from unnecessary anti-TB therapy and treatment of the primary disease (ie, CD) gets delayed. We therefore aimed to assess the accuracy of various parameters that can be used to predict GITB diagnosis at index evaluation.Materials and methods: This was a prospective, unicentric, observational study carried out in the gastroenterology department of a tertiary care hospital between August 2011 and January 2013. Patients who presented to our hospital and were suspected of having GITB were included in our study. Patients were then followed up over a 6-month period.Statistical analysis: Chi-square test was used to analyze the data.Results: Of the 69 patients with GITB, 49 (71.01%) had thickening of the involved part of the colon and 33 (47.83%) had abdominal lymphadenopathy. The ileocecal valve was involved in 58 patients (84.05%) Histological detection of granulomas had 78.95% specificity, 36.23% sensitivity, and 51.40% accuracy. Tuberculosis polymerase chain reaction was found to have 78.95% specificity, 71.01% sensitivity, and 73.83% accuracy. BACTEC-MGIT culture was found to have 100% specificity, 20.29% sensitivity, and 48.60% accuracy.Conclusion: Although histology is helpful in ruling out other conditions, TB-specific findings such as caseating granuloma and acid-fast bacilli are rarely seen. Instead, tuberculosis polymerase chain reaction has the highest diagnostic accuracy followed by BACTEC culture. Keywords: gastrointestinal tuberculosis, colonoscopy, TB polymerase chain reaction, BACTEC culture, antituberculous treatment, biops