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Gastric perforation secondary to Rapunzel syndrome
  1. Jamaall Jackman,
  2. Gael R Nana,
  3. James Catton and
  4. Ioannis Christakis
  1. General Surgery, Queen's Medical Centre Nottingham University Hospital NHS Trust, Nottingham, UK
  1. Correspondence to Jamaall Jackman; drjamaall.jackman{at}


Rapunzel syndrome is rare and describes a trichobezoar that extends through the pylorus into the jejunum, ileum or even the colon. Due to the large intraluminal size and weight they can attain, acute presentations of obstruction or perforation may occur. We report a case of a 17-year-old girl who presented to the emergency department following a syncopal episode. On examination, a left upper quadrant mass was appreciated with no signs of peritonism. Contrast-enhanced CT demonstrated a giant trichobezoar with resulting gastric perforation and intra-abdominal free fluid. Laparotomy and gastrotomy were performed and the patient had an uneventful recovery with psychiatric review prior to discharge. Though uncommon, bezoars should be included in our differential diagnosis as they can present in various ways owing to their size and weight. This case illustrates the risk of gastric perforation with large gastric bezoars.

  • gas/free gas
  • stomach and duodenum
  • nutritional support
  • gastrointestinal surgery

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  • Contributors All authors gave substantial contribution to the conception for case review and presentation. All authors drafted, reviewed and was in agreement on the final product of the manuscript and its contents.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.