Duodenal diastatic perforation due to double gastric and jejunal trichobezoar in a patient with Rapunzel syndrome.

Rapunzel syndrome is a rare clinical entity in which a trichobezoar is produced by the ingestion of hair at the gastric level, extending in the form of a tail towards the duodenum. It occurs in young patients with trichotillomania and trichophagia. We present the case of a 24-year-old woman with a history of anxiety without treatment, who for 10 years presented trichotillomania and trichophagia, producing a picture of intestinal obstruction that required surgical intervention, evidencing a giant Trichobezoar throughout the gastric cavity and one jejunum associated with diastatic perforation. duodenal.

Intraperitoneal Onlay Mesh Technique for Spigelian Hernia in an Outpatient and Short-Stay Surgery Unit: What's New in Intraperitoneal Meshes?

BACKGROUND: Spigelian hernia (SH) is a rare entity, but its surgical treatment is essential because of its high complication risk. Laparoscopic approaches have become the option in elective surgery because it has less morbidity and requires a shorter stay. Several laparoscopic techniques have been employed, but there is no gold standard technique for this kind of hernia. We report, in this study, our experience with intraperitoneal onlay mesh (IPOM) repair. MATERIALS AND METHODS: Fifteen patients underwent elective surgery for SH between 2008 and 2015 in a Short-Stay Surgical Unit. Laparoscopic IPOM technique was performed in all patients. The technique, epidemiological data, operative findings, hospital stay, morbidity, and follow-up are presented. RESULTS: Fifteen patients (8 males) with a median age of 57 years were operated on. They commonly presented an abdominal mass in the flank (73.3%). Computed tomography was necessary in 4 patients to complete preoperative diagnosis. The mean operating time was 43 minutes. No closure of the defect was associated and we employed expanded polytetrafluoroethylene-coated and polyvinylidene fluoride-coated polypropylene meshes. There were no postoperative complications and early discharge was possible in all cases. No recurrences or complications related to the mesh have been detected so far, with a median follow-up of 4 years (1-8). CONCLUSIONS: Our experience shows IPOM laparoscopic SH repair is a safe and effective technique with advantages that allow us to recommend it as the most advisable for SH treatment in Short-Stay Surgical Units. However, current controversies in the use of intraperitoneal meshes must be clarified.