Page 169 - Abstract Book KONIKA 18

Emergency & Pediatric Intensive Care

P-EPIC-017
Intensive Care Management in Post-operative Ileal Obstruction
due to Rapunzel Syndrome in a 10-year-old Girl Patient: A Rare Case Report

Irene Yuniar, Rizky Amaliah, Cynthia Centauri, Annisa Rahmania Yulman, Fahreza Aditya Neldi,
Srisadono Fauzi Adiprabowo, Vandra Davin, Endah Setyaningsih
Universitas Indonesia Hospital, Depok, West Java, Indonesia

Abstract
Background The Rapunzel syndrome is an unusual form of trichobezoar found in patients with a history
of psychiatric disorders, trichotillomania and trichophagia, consequently developing gastric bezoars.
It's an extremely rare condition and till date just about 50 cases have been described in the literature.
Objective To report a case of ileal obstruction as a manifestation of Rapunzel syndrome. Case A-10-year-
old girl was presented to emergency room with bilious vomiting after eating and couldn't defecate or no
flatulence in 3 days. On the physical examination abdomen was distended and no bowel sound. Abdominal
radiography showed ileal obstruction. Emergency laparotomy was performed and there was obstruction with
strangulate of ileal caused by hair (trichobezoar). Further investigations after surgery revealed that this patient
has a habit of eating strands of hair. This patient was diagnosed as Rapunzel syndrome with trichophagia and
strangulation of ileal obstruction. Post-operative management is important to get good outcome. This patient
treated with hydration fluid with GIR 4-6 mg/kg/minute to achieve zero-fluid balance and good control of
blood glucose, combination of antimicrobe (third generation of cephalosporin and metronidazole), analgetic
for pain management, and supportive psychotherapy. Conclusion Trichobezoar, an under-diagnosed entity,
has to be considered in the differential diagnosis of abdominal pain and a history of trichophagia. Surgery is
the initial treatment, but a comprehensive treatment with appropriate medication and long-term post-operative
psychiatric follow-up is needed in patient with Rapunzel syndrome.
Keywords: Rapunzel syndrome; trichobezoar; ileal obstruction

Figure 1. Hair removal

KONIKA XVIII Abstract Book 121