RAPUNZEL SYNDROME WITH GASTRIC PERFORATION IN AN ADULT

Rapunzel syndrome is a rare condition of gastric trichobezoar with contiguous extension in the intestines found commonly in pediatric and teenage patients, mostly females, with underlying psychological disorders. We report the case of a 37‐year‐old widow who presented with epigastric pain, fullness and early satiety of 6 months duration. Investigations revealed a trichobezoar extending from the stomach through the duodenum into the jejunum. Psychiatric analysis revealed depressive symptoms. She was posted for elective surgery; however, 2 days prior to the surgery she presented with acute abdomen with plain X‐ray of the chest and abdomen showing free gas under the diaphragm. Urgent laparotomy was carried out which confirmed the diagnosis of gastric perforation due to Rapunzel syndrome. The perforation was closed primarily along with removal of the trichobezoar en masse by anterior gastrotomy. This is the first case of Rapunzel syndrome with gastric perforation that has presented in the fourth decade of life. Here we discuss the etiology, pathogenesis, diagnosis and treatment of this unusual syndrome.