The rapunzel syndrome: report of a case and review of the literature

The Rapunzel Syndrome, a rare manifestation of trichobezoar, occurs when bolus gastrointestinal obstruction is produced by an unusual trichobezoar with a long tail that extends to or beyond the ileocaecal valve. A five-year-old Jamaican girl presented with this abnormality and was found at laparotomy also to have an ileo-ileal intussuception. For the Rapunzel Syndrome, we recommended bezoar extraction at laparotomy via multiple enterotomies. In addition, psychiatric evaluation and therapy is essential due to the commonly associated finding of underlying emotional stress. (AU)

Unusual lower GU tract gunshot injuries - abstract

With over 100 gunshot injuries seen at the University Hospital of the West Indies and the Kingston Public Hospital annually and with lower GU injuries occurring in approximately eight per cent of cases, it is not surprising that unusual trauma pathology will occur in this region. Described are four cases seen over a six-month period where the courses of the bullets almost defy an anatomical explanation. In two, the entry site was in the buttock with entry into the bladder through the posterior wall without causing bowel injury. In another, the entry wound was also lodge in the lumen of the bulbous urethra. In the other case, the skin entry wound was in the lower anterior abdominal wall with exit through the posterior inferior wall of the urinary bladder just above the mid trigone, again somehow avoiding bowel to finally lodge in the buttock. It is impossible to explain any of the above pathology if it is assumed that the bullets travelled on a straight course. Seemingly, their trajectories were altered, allowing the path of least resistance to be taken, thereby pushing structures with mobile walls out of their way. It is theoretically possible that the high pressure area that precedes a high velocity bullet pushes mobile structures out of harm's way (AU)