El largo camino de la tricotilomania al síndrome de Rapunzel / The Long Road from Trichotillomania to Rapunzel Syndrome

Introducción: La tricotilomania, la tricofagia y el tricobezoar son afecciones entrelazadas e interconectadas. Estas deben tenerse en cuenta especialmente en féminas jóvenes que a menudo tienen una enfermedad psiquiátrica o trastorno social subyacente y es posible que la historia sea difícil de obtener. Objetivo: Presentar un caso portador de tricobezoar gástrico, por su baja incidencia en nuestro medio y a nivel mundial. Caso clínico: Paciente femenina de 12 años de edad, con antecedentes de retraso psicomotor, sin seguimiento o tratamiento previo. Acudió a consulta traída por su madre que aduce aumento de volumen en hemiabdomen superior de 5 años de evolución con pérdida de peso insidiosa. Los estudios radiológicos revelaron un tricobezoar gástrico que se corrobora, asociado a un síndrome de Rapunzel, en la laparotomía exploratoria. La paciente evolucionó satisfactoriamente y es seguida por grupo multidisciplinario. Conclusiones: Los bezoares gástricos son entidades poco frecuentes. Para el diagnóstico es necesario un alto índice de sospecha de conjunto con estudios radiográficos y/o endoscópicos. El tratamiento estará determinado por el tipo de bezoar, tamaño y consistencia. La opción quirúrgica es la más usada, con el consecuente seguimiento interdisciplinario para evitar recurrencias(AU)

Introduction: Trichotillomania, trichophagia and trichobezoar are intertwined and interconnected conditions. These should be considered, especially in young women who often have an underlying psychiatric illness or social disorder and possibly a history difficult to get. Objective: To report a case of gastric trichobezoar due to its low incidence in our environment and worldwide. Clinical case report: We report the case of a 12-year-old female patient with a history of psychomotor retardation, with no prior follow-up or treatment, who came to consult with her mother, complaining of increased volume in the upper abdomen, of 5 years of evolution with malignant weight loss. Radiological studies reveal a gastric trichobezoar that is corroborated, associated with Rapunzel syndrome, in the exploratory laparotomy. The patient evolved satisfactorily and a multidisciplinary group assisted her. Conclusions: Gastric bezoars are rare entities. Diagnosis requires high level of suspicion together with radiographic and/or endoscopic studies. The treatment will be determined by the type of bezoar, size and consistency. The surgical option is the most used, requiring interdisciplinary follow-up to avoid recurrences(AU)

Síndrome de Rapunzel: mito o realidad / Rapunzel Syndrome: Myth or Reality

Resumen Se presenta el caso de una paciente de 35 años, quien ingresa al servicio de urgencias de un hospital de tercer nivel, por causa de un cuadro de 6 meses de saciedad precoz, pérdida de peso y, en el momento del examen físico de ingreso, se observan signos de desnutrición. En consecuencia, se realiza una endoscopia de las vías digestivas altas en las que se descubre un tricobezoar que ocupa toda la cámara gástrica y se extiende más allá de la tercera porción del duodeno. Mediante una tomografía axial computarizada (TAC) de abdomen, se confirma la presencia de una lesión que ocupa la cámara gástrica y el duodeno, por lo que la paciente es conducida a cirugía. Allí se encuentra el tricobezoar que confirma el diagnóstico de síndrome de Rapunzel. Luego de la cirugía, la paciente presenta una adecuada evolución posoperatoria, con resolución de los síntomas de ingreso. Asimismo, se inicia una intervención por nutrición y psicología, a fin de manejar la desnutrición y el trastorno psiquiátrico de base.

Abstract A 35-year-old patient was admitted to the emergency department of a third-level hospital following six months of early satiety and weight loss. Upon physical admission, the patient had signs of malnutrition. Upper digestive tract endoscopy found a trichobezoar that occupied the entire gastric chamber and extended into the third portion of the duodenum. This diagnosis was confirmed by an abdominal CT scan. Surgery confirmed the diagnosis of Rapunzel Syndrome. Following surgery the patient's evolution was good and symptoms resolved. Nutritional and psychological interventions were initiated to manage malnutrition and an underlying psychiatric disorder.

Trichobezoars: a hairy cause of intestinal obstruction

Trichobezoars are an infrequent form of bezoar found in the stomach or intestine, created from ingested hair. Their most frequent location is in the stomach but they may extend through the pylorus into the small bowel. This condition is known as Rapunzel syndrome. Trichobezoar with Rapunzel syndrome is an uncommon diagnosis in children. Authors report 3 cases of Rapunzel syndrome with a large bezoar in paediatric age group that presented with features of acute intestinal obstruction. They were managed with surgical exploration.

Gastric trichobezoar and Rapunzel syndrome: a case report

Giant gastric trichobezoars are unusual form of foreign body found in stomach of mostly young adolescent females which may lead to morbidity and high mortality 30%, if goes unnoticed. These females have history of trichophagia or trichotillomania. This report is of a 12- year old young adolescent female presented with epigastric pain and mass. An exploratory laparotomy with anterior gastrotomy was performed and a giant trichobezoar with a very large tail of 2.5 ft was removed, weighing 2.52 kg. She recovered well and was discharged on 7th post-operative day. Patient was advised for psychiatric follow up.

Trichobezoars as a cause of intestinal obstruction in a young female

A bezoar is a mass found trapped in the gastrointestinal system, though it can occur in other locations. There are various types of bezoars including food boluses, lactobezoar, pharmacobezoar, phytobezoar, diospyrobezoar and trichobezoar. They are common in children and adolescents, and 90% of the patients are women. Complications may manifest as gastric outlet obstruction or bleeding and intestinal obstruction. CT is the preferred image modality for the evaluation of suspected trichobezoars in order to characterize the size, location, presence and level of obstruction and complications such as ischemia or perforation. Here authors present a case to stress the importance of considering trichobezoars as one of the causes for intestinal obstruction in young females.

Tricobezoar: presentación de caso / Trichobezoar: presentation of case

Los tricobezoares pertenecen a la clasificación de los bezoares, tumores abdominales formados por el acumulo de diversas sustancias que pueden ocasionar la oclusión intestinal, se presenta un paciente, femenina, que acuda al médico por presentar dolor abdominal y vómitos, en el examen físico abdominal se palpa una masa de aproximadamente 5 cm en el epigastrio que aparece y desaparece con los movimientos intestinales, se plantea inicialmente la posibilidad de padecer de una neoplasia abdominal, se realiza una endoscopia en donde informe que, en el fondo gástrico, cuerpo y antro está ocupado por cabello y restos alimenticios mal digeridos, la cual es removida mediante una laparotomía sobre el área que ocupaba la tumoración en el intestino delgado extrayendo un tricobezoar de 35 cm de longitud por 10 de ancho(AU)

The trichobezoars belong to the classification of bezoars, abdominal tumors formed by the accumulation of various substances that can cause intestinal occlusion, a patient, female, who comes to the doctor due to abdominal pain and vomiting, in the abdominal physical examination is presented palpa a mass of approximately 5 cm in the epigastrium that appears and disappears with bowel movements, initially poses the possibility of suffering from an abdominal neoplasm, an endoscopy is performed where it reports that, in the gastric fundus, body and antrum is occupied by hair and badly digested food remains, which is removed by a laparotomy on the area occupied by the tumor in the small intestine, extracting a trichobezoar measuring 35 cm long by 10 cm wide(AU)

Síndrome de Rapunzel con doble tricobezoar simultáneo en una adolescente: Reporte de caso / Rapunzel syndrome with double simultaneous trichobezoar in a teenager: Clinical Case Report

Resumen: Introducción: Los tricobezoares son acúmulos intraluminales de cabello ingerido. El síndrome de Rapunzel hace referencia a la presencia de los tricobezoares gástricos que se extienden al intestino delgado, sumados a la tricotilomanía y tricofagia, los cuales ocurren preferentemente en pacientes psiquiátricos en edad pediátrica. Objetivo: Analizar la aparición y manejo de este síndrome, propor cionando de igual manera datos acerca del entorno familiar y psicoemocional para que, por medio del análisis de los mismos, en un futuro se pueda identificar el riesgo en pacientes con circunstancias similares. Caso clínico: Paciente femenina de 14 años con antecedentes de tricotilomanía y tricofagia de dos años de evolución, que consultó por cuadro de dolor epigástrico asociado a sensación de plenitud posprandial, náuseas y pérdida de peso. Al examen destacaban áreas alopécicas en el cuero cabelludo y a la palpación abdominal se identificó un plastrón cuyo contorno parecía corresponder a los límites gástricos. En los estudios de imágenes se encontró una ocupación gástrica por bezoar. Con la laparotomía más gastrostomía se identificaron dos tricobezoares simultáneos en estómago y duodeno, que fueron resueltos quirúrgicamente y la paciente fue manejada con abordaje psicoemocional. Conclusión: El síndrome de Rapunzel, lejos de ser meramente una entidad quirúrgica, requiere un apoyo psicoemocional para prevenir su recurrencia y limitar su severidad.

Resumen: Introduction: Trichobezoars are an intraluminal accumulation of ingested hair. The Rapunzel syndrome refers to the presence of gastric trichobezoars which extend to the small intestine together with trichotillomania and trichophagia, that occur predominantly in psychiatric patients of pediatric age. Objective: To analyze the clinical course and resolution of this syndrome in a case report. Likewise, we provide information about the family environment and psycho-emotional context of the patients and help the reader identify similar circumstances in their clinical practice. Case report: Female 14-year-old patient with history of trichotillomania and trichophagia of two years of evolution, who consulted for epigastric pain associated with weight loss, nausea, and postprandial fullness. During the physical examination, the patient was found to have bald patches in the scalp along with a palpable mass that seemed to be confined to the gastric limits. Imaging studies revealed gastric occupation due to a bezoar formation. The patient was treated surgically with laparotomy and gastrostomy, and two simultaneous trichobezoars were removed from the patient´s stomach and duodenum, the patient also underwent psycho-emotional professional counseling. Conclusion: Rapunzel´s syndrome, far for being a merely surgical entity, also requires psychoemotional assessment to prevent it recurrence and limit its severity.

Síndrome de Rapunzel en una adolescente: causa de suboclusión intestinal / Rapunzel syndrome in teenager: Intestinal subocclusion cause

Resumen Objetivo: Presentar un caso de síndrome de Rapunzel. Esta es una enfermedad poco frecuente que consiste en una variante de tricobezoar gástrico que se extiende hasta la segunda porción del duodeno. Caso clínico: Paciente femenina adolescente con antecedentes de atresia tricuspídea tratada quirúrgicamente. Presentó dolor abdominal de 3 días de evolución en el hipocondrio izquierdo irradiado al hipocondrio derecho, con distensión abdominal, náuseas y vómitos. Al examen físico presentó un perímetro abdominal de 58 cm y ruidos hidroaéreos disminuidos. La laparotomía exploratoria con gastrostomía anterior mostró una masa de cabellos entrelazados de aproximadamente 40 cm de longitud, compatible con tricobezoar, que se extendió desde el fondo gástrico hasta la segunda porción, llamado síndrome de Rapunzel, provocando suboclusión intestinal. Conclusión: El diagnóstico temprano permite evitar complicaciones, que pueden ser graves. Se recomienda un manejo multidisciplinario con el servicio de psiquiatría para controlar la enfermedad de base.

Abstract Aim: Present a case of Rapunzel syndrome, this is a rare disease that is a variant of gastric tricobezoar which extends to the second portion of duodenum. Case report: Female patient with tricuspid atresia treated surgically. Abdominal pain three days of evolution on the left upper quadrant radiating to the right upper quadrant with abdominal distension, nausea and vomiting. Abdominal circumference was 58 cm, decreased bowel sounds. The exploratory laparotomy presenced of a mass formed by interlocking hair, approximately 40 cm long with a compatible tricobezoar that spread from the gastric fundus to the duodenum called Rapunzel síndrome and caused partial bowel obstruction. Conclusion: Early diagnosis can prevent complications, which can be severe, a multidisciplinary management is recommended in psychiatry service to control the underlying disease.

Tricobezoar. reporte de caso / Tricobezoar - case report / Trichobezoar - estudo do caso

El Tricobezoar es la acumulación de pelo en el tracto gastrointestinal generalmente asociado a trastornos psiquiátricos que conlleva a sintomatología obstructiva, deficiencias metabólicas y puede llevar a perforación intestinal, pancreatitis, intususcepción y colangitis. Caso: Paciente femenina de 11 años con cuadro clínico de 1 semana de evolución de dolor abdominal en epigastrio asociado a ausencia de deposiciones y antecedente de cuadro similar hace 2 semanas que resolvió con enema oral, se documentó Tricobezoar de 13 x 5 cm que generaba gran distensión en asas intestinales que fue removido por laparotomía con éxito. Conclusiones: Es una patología poco común asociada a un trastorno psicológico, que debe ser manejada quirúrgicamente en pro de prevenir complicaciones e incluye un tratamiento conjunto con psiquiatría y psicología para evitar recurrencias.

The Trichobezoar is the accumulation of hair on the gastrointestinal tract associated with psychiatric disorders generally leading to obstructive symptoms, metabolic deficiencies and, in some cases, intestinal perforation, pancreatitis, cholangitis or intussusception. Case: 11 years old female patient with clinical symptoms of 1 week duration of epigastric abdominal pain associated with bowel movements, patient referred history of similar symptoms two weeks ago that resolved with oral enema, tomography revealed a Trichobezoar 13 x 5 cm generating large strained bowel loops which was successfully removed by laparotomy. Conclusions: Trichobezoar is a rare entity associated with a psychological disorder that needs to be handled surgically towards preventing complications and includes a set psychiatric and psychological treatment to prevent recurrences

Trichobezoar é o acúmulo de pêlos no trato gastrointestinal associado com transtornos psiquiátricos geralmente levando a sintomas obstrutivos, deficiências metabólicas e, em alguns casos, perfuração intestinal, pancreatite, colangite ou intussuscepção. Caso: Paciente do sexo feminino com 11 anos de idade com sintomas clínicos de 1 semana de duração da dor abdominal epigástrica associada a movimentos intestinais, paciente relatou história de sintomas semelhantes há duas semanas que resolveram com enema oral, a tomografia revelou um tricobezoar de 13 x 5 cm, foi removido com sucesso por laparotomia. Conclusões: Trichobezoar é uma entidade rara associada a um transtorno psicológico que precisa ser tratado cirurgicamente para prevenir complicações e inclui um conjunto de tratamento psiquiátrico e psicológico para prevenir recorrências

Stomach trichobezoar (rapunzel syndrome) with iatrogenic intussusception

We present a rare case of stomach trichobezoar complicated with iatrogenic intussusception noted intra-operatively after failed attempt of endoscopic removal in a 13-year-old girl. At presentation, she had gastric outlet obstruction with anaemia. Endoscopy established the diagnosis of trichobezoar. Surgical removal was warranted after failed endoscopic removal. Her postoperative course was uneventful. Detailed history and careful examination disclosed trichotillomania and associated trichophagia. Psychiatric referral was sought with the intention to prevent future recurrence.

Tricobezoar, a proposito de un caso / Tricobezoar, a case report

El tricobezoar es una masa de cabello no digerido que se encuentra en las vías gastrointestinal. Se alojan frecuentemente en el estómago pero se pueden ubicar a todo lo largo del tracto gastrointestinal. Se observan en sexo femenino en el 90% de los casos, y con una mayor frecuencia entre los 10 y 19 años. Se presenta el caso de una adolescente femenina de 11 años de edad quien cursa con enfermedad actual de 1 mes de evolución caracterizada por dolor abdominal, vómitos alimenticios pospandriales y pérdida de peso. Al examen se palpa una masa que ocupa el hemiabdomen superior. Se realiza tomografía computarizada de abdomen donde se evidencia imagen hipodensa y heterogénea que ocupaba la totalidad del estómago, compatible con cuerpo extraño. Se realiza laparotomía exploradora donde se evidencia tricobezoar gástrico.

Trichobezoar is a mass of undigested hair found within the gastrointestinal tract. They are often found in the stomach but may be found along the entire gastrointestinal tract. 90% of the cases occur in females between the age of 10 and 19 years. We present the case of an 11 years old girl who suffered abdominal pain, vomiting and weight loss for a month, with a palpable mass located in the upper abdomen quadrant. Abdomen computed tomography reported a hypodense heterogeneous image which occupied the whole of the stomach, compatible with foreign body. At laparotomy a gastric tricobezoar was found.

Rapunzel Syndrome: Trichobezoar in a 15-Year-Old Female Patient: A Case Report.

Rapunzel syndrome is a type of trichobezoar, a very rare to find in clinical settings, wherein the hairball tail extends in small bowel. Patient may present with varying signs ranging from vague abdominal pain to signs of intestinal obstruction. This case describes averagely built, averagely nourished young female of 15 years of age, no e/o anemia, jaundice, lymphadenopathy; per abdominal examination revealed an elliptical lump in epigastric region extending to umbilical region, lump was not freely mobile and non-tender. Early gastroscopy is indicated in patients with long history of vague abdominal pain, weight loss and hair loss in young females.

A rare case of paediatric trichotillomania complicating into Rapunzel syndrome: a case report

Background: Trichotillomania is a psychological condition that involves strong urge to pull one’s hair. Trichophagia is disorder of eating of hair. Bezoar is collection of undigested material such as hair, drugs and plastic or combinations. Rapunzel syndrome is a rare type of trichobezoar, which has mass of hair lodged in stomach extending up to ileum. In majority, diagnosis is made very late, at a stage where surgery is the only option. Case description: A 9 year old girl was brought with complaints of loss of hair on scalp since 8 months, decreased appetite, and constipation, weight loss since 5 months and vomiting since 2 weeks. Patient had paediatric consultations without much benefit; patient was referred to dermatologist and paediatric surgeon. Ultrasound showed mass in abdomen. Patient was operated to find a mass extending from stomach to terminal ileum. Patient was referred to a Psychiatrist and diagnosis of Trichotillomania was made. Discussion: Trichobezoar is common in young females, often with an underlying psychiatric disorder, they present late due to the low index of suspicion. As this condition is a rarity in paediatric age group and very little progress to Rapunzel syndrome, this paper discusses about the systemic team management of the above individual. Conclusion: High index of suspicion is needed to diagnose this condition in paediatric age group.

Small Bowel Volvulus with a Jejunal Trichobezoar.

Background: Small bowel volvulus caused by a jejunal trichobezoar is an extremely rare and life-threatening emergency in children. Case characteristics: An 8-year-old girl with abdominal pain and persistent bilious vomiting. Observation: The abdominal computed tomography scan showed a solitary intraluminal mass and a whirl sign, suggesting the small bowel volvulus. Emergency laparoscopic exploration revealed the rotated segment of small bowel loops by a jejunal trichobezoar. Outcome: Satisfactory recovery after surgery. Message: Trichobezoars should be considered in the differential diagnosis of abdominal pain and projectile vomiting in children.

Síndrome de retención gástrica por Tricobezoar / Gastric retention syndrome due to tricobezoar

RESUMEN Los bezoares son masas sólidas compuestas por fibras, pelos o restos de comida ingeridos que generalmente permanecen en el estómago. Los tricobezoares, que están formados por pelos, son más comunes en el sexo femenino en edad pediátrica con antecedentes de tricotilomanía y tricofagia. Para el diagnóstico se utilizan imágenes como la radiografía simple de abdomen, la radiografía de abdomen con bario y la endoscopia digestiva alta que permite la visualización directa. El tratamiento del tricobezoar es quirúrgico, con gastrostomía anterior, además de apoyo psiquiátrico. Este caso corresponde a una paciente de 16 años con antecedentes de tricofagia, que consulta por un cuadro de dolor abdominal, vómitos y distensión abdominal. Se realiza estudios laboratoriales, imagenológicos y endoscópicos llegando al diagnóstico de obstrucción intestinal mecánica alta. Se indicó cirugía y se confirmó tricobezoar que es extraído por gastrotomía anterior. La evolución fue favorable, por lo cual egresó al quinto día del post operatorio, con recomendaciones de asistir a consultas externas de cirugía general y psicología.

ABSTRACT Bezoars are solid masses made up of fibers, hairs or food debris that usually remain in the stomach. Trichobezoars, which are formed by hairs, are more common in female patients with a history of childhood trichotillomania and trichophagia. For diagnosis, imaging techniques like plain abdominal radiography, barium contrast abdominal radiography and upper gastrointestinal endoscopy are used that allow direct visualization. Treatment for trichobezoar is surgical, consisting of anterior gastrostomy in addition to psychiatric support. Our case corresponds to a 16-year old patient with a history of trichophagia, that consulted for abdominal pain, vomiting and abdominal distension. Laboratory, imaging and endoscopic studies were conducted leading to the diagnosis of higher intestinal mechanical obstruction. Surgery was indicated confirming the trichobezoar that was removed by anterior gastrostomy. Evolution was favorable, whereby the patient egressed five days after surgery, with recommendations to attend outpatient general surgery and psychology.

Rapunzel Syndrome : A Rare Cause of Vomiting and Pain Abdomen.

Bezoar is an agglomeration of food or foreign material in intestinal tract. Contiguous extension of trichobezoar into the small bowel can lead to the Rapunzel syndrome. We present rare case of Rapunzel syndrome in 16 year old female who presented with recurrent vomiting.

Trichobezoar Presenting as Acute Abdomen.

Trichobezoar is a ball of swallowed hair that collects in the stomach and fails to pass through the intestine. The risk is greater among mentally ill females. Here in we describe a mentally normal female presenting with acute abdomen and firm mass in the abdomen with muscular defence.

Tricobezoar / Trichobezoar

Cuando los cuerpos extraños permanecen en el tubo digestivo del hombre por largo tiempo y resisten la acción de los jugos digestivos, forman concreciones a las que se les denomina bezoares. Los bezoares pueden estar compuestos por uno o varios tipos de materia, como los pelos de las personas (tricobezoares). En este trabajo se analiza el caso de una paciente femenina, de 24 años de edad, procedencia rural, que acude a servicio de urgencias por la presencia de dolor abdominal difuso, fundamentalmente en epigastrio, y que se irradia a todo el abdomen; además presenta vómitos y diarreas que contienen pelos. La endoscopia digestiva alta evidenció un cuerpo extraño que ocupaba toda la luz gástrica. Se realizó laparotomía exploradora y gastrotomía longitudinal anterior, en la que se encontró una gran masa compacta de aspecto oscuro. El informe anatomopatológico de la pieza, describió una muestra con forma de masa alargada, compuesta por pelo procedente del cuero cabelludo

When foreign bodies remain in the human digestive tract for a long time and tolerate the digestive juices, the produce concretions called benzoars, which may be composed by one of several types of matter, by example the hairs (trichobezoars). The objective of present paper is to analyze the case of a female patient aged 24 arriving from rural zones, who came to emergency services due to a diffuse abdominal pain, mainly in epigastrium irradiating to all the abdomen; also, had vomiting and diarrheas containing hairs. The high digestive endoscopy demonstrated a foreign body occupying all the gastric lumen. An exploratory laparotomy and anterior longitudinal gastrotomy were carried out noting a large compact mass of obscure appearance. The sample anatomical-pathological report described an enlarged mass consisting of hair from the scalp

Tricobezoar complicado com retropneumoperitoneo: relato de caso. / Trichobezoar complicated wihh retropneumoperitoneum: case report

Objetivo: relatar o caso de uma criança que se apresentou com quadro clínico de dor abdominal a esclarecere chamar a atenção para a possibilidade do diagnóstico precoce de bezoar. Relato de caso: criança, 09 anos,com quadro de dor epigástrica intensa e massa palpável no abdome. Foi submetida a examescomplementares que levantaram a possibilidade de semi-oclusão e corpo estranho. Submetida à laparotomiaexploradora para retirada de tricobezoar gastro-duodenal; evoluiu sem intercorrências e teve alta paraacompanhamento ambulatorial. Conclusão: fica evidente a importância do diagnóstico precoce de bezoar,face às complicações que podem advir desta condição, e da abordagem multidisciplinar, para o completorestabelecimento do paciente.

Objective: report a case of a child who presented clinical symptoms of abdominal pain, and draw attentionto the possibility of early diagnosis of bezoar. Case report: child, 09 years, with signs of severe epigastricpain and palpable mass in the abdomen. Underwent additional tests that raised the possibility of semiocclusionand foreign body. Subjected to laparotomy for removal of gastro-duodenal trichobezoar,progressed uneventfully and was discharged for outpatient monitoring. Conclusion: It is clearly theimportance of early diagnosis of bezoar, given the complications that may arise from this condition, and themultidisciplinary approach to the patient full recovery.

Síndrome de Rapunzel: reporte de caso y revisión de la literatura / Rapunzel syndrome: a case report and literature review

Los tricobezoares son una condición poco común que usualmente ocurre en mujeres jóvenes con una historia de tricotilomanía y tricofagia. En la actualidad, la mayoría de los casos se presentan en pacientes con antecedentes de cirugía gástrica, o con alteraciones en la función pilórica; clínicamente pueden cursar asintomáticos durante meses o años o presentarse como una entidad aguda acompañada por sus complicaciones. En el presente artículo se presenta el caso clínico de una paciente embarazada a quien se le realizó diagnóstico de tricobezoar gastroduodenal - síndrome de Rapunzel (una variedad compleja de este bezoar que involucra estómago, duodeno e intestino); se presenta una revisión de la literatura al respecto.

The presence of trichobezoars is a rare condition which usually occurs in young women who have histories of trichotillomania and trichophagia. Nowadays, the majority of cases occur in patients with a history of gastric surgery, or pyloric function alteration. They may be clinically asymptomatic for months or years or may present acute symptoms accompanied by severe complications.This article presents the case of a pregnant patient who was diagnosed with a case of Rapunzel syndrome a is presented. This complex variety of gastroduodenal trichobezoar involves the stomach, duodenum and intestine. The article also reviews the literature about the Rapunzel syndrome.