CASO CL\ucdNICO. SINDROME DE RAPUNZEL: UNA FORMA INUSUAL DE TRICOBEZOAR

Abstract

El S\uedndrome de Rapunzel es una forma inusual de tricobezoar g\ue1strico con extensi\uf3n al intestino delgado, capaz de producir s\uedntomas gastrointestinales desde dolor, nauseas, v\uf3mitos incluso obstrucci\uf3n y perforaci\uf3n intestinal. Paciente femenino de 19 a\uf1os de edad quien ingresa al Hospital Central Universitario Antonio Mar\ueda Pineda con enfermedad actual de 15 d\uedas de evoluci\uf3n caracterizada por dolor epig\ue1strico acompa\uf1ado de nauseas y v\uf3mitos postpandriales de intensidad progresiva evidenci\ue1ndose al examen f\uedsico una masa epig\ue1strica palpable de aproximadamente 15cm de di\ue1metro, de consistencia dura, no dolorosa, m\uf3vil, no adherida a planos profundos. Se realiza TAC abdominal donde se observa imagen heterog\ue9nea con capas conc\ue9ntricas alternas con aire que ocupa estomago, fundus, cuerpo y antro con paso escaso de contraste a intestino delgado. Se lleva a mesa operatoria encontr\ue1ndose tumoraci\uf3n que ocupa la totalidad de la c\ue1mara g\ue1strica extendi\ue9ndose a duodeno, compuesta por pelos, moco y restos alimentarios realiz\ue1ndose remoci\uf3n de la totalidad de la misma a trav\ue9s de una gastrostomia anterior. Resultados: Evoluci\uf3n postoperatoria satisfactoria desde el punto de vista medico quir\ufargico. La paciente es referida a consulta de psiquiatr\ueda por tricotilomania y tricofagia. Conclusi\uf3n: el S\uedndrome de Rapunzel es una entidad cl\uednica infrecuente de la cual existen pocos casos reportados en la literatura y que ocurre cuando un tricobezoar g\ue1strico con cola se extiende mas all\ue1 del piloro al intestino delgado incluso colon produciendo s\uedntomas gastrointestinales.THE RAPUNZEL SYNDROME: AN UNUSUAL FORM OF TRICHOBEZOAR ABSTRACT Background: the Rapunzel syndrome is an unusual form of gastric trichobezoar which extends toward the small intestine and may produce gastrointestinal symptoms ranging from pain, nausea, vomiting, and even intestinal obstruction and perforation. Case report: A female 19 years old patient is admitted to the Hospital Central Universitario Antonio Maria Pineda with current disease of 15 days of evolution, featuring epigastralgia and postprandial nausea, and vomiting of increasing intensity. On physical examination, an epigastric palpable mobile firm mass of 15 cm of diameter is found, which was painless and not adherent to surrounding planes. An abdominal CAT scan is performed, showing heterogenic images with alternate concentric layers and air occupying stomach, fundus, body and antrum, with weak pass of contrast toward the small intestine. Patient underwent surgery, where a tumor occupying the whole gastric chamber was found, extending toward the duodenum. The tumor was made up by hairs, mucus and food fragments, which were totally removed by an anterior gastrostomy. Results: postoperative evolution was satisfactory, from a medical-surgical approach. Patients was referred to the psychiatric service, were both her trichologia and trichophagia were attended. Conclusion: Rapunzel syndrome is an uncommon clinic entity with very few cases reported in literature, and occurs when a tailed gastric trichobezoar extends beyond pylorus toward the small intestine, even to colon, producing gastrointestinal symptoms