KINDERRADIOLOGIE ONLINE - view radiology images and radiology cases
Lesen Sie diese Seite auf Deutsch   Read this page in English
The Peer Reviewed Pediatric Radiology Platform on the Web
ISSN: 1942-955X :: Publisher: EduRad ::Editor-In-Chief: Roland Talanow, MD, PhD  
Browse Browse || Search Search || Online Book Systematically Online Book Systematically || Discussion Forum Discussion Forum || News News || Submit a Case Submit a Case || Rules Rules |
Most Interesting Cases Most Interesting Cases || "Most Diligent" Authors "Most Diligent" Authors || Case of the Day Case of the Day || Teaching files Teaching files || Links Links |
Newsletter Newsletter || Start Start || Survey Survey || Your Opinion Your Opinion || My Profile My Profile || CME-Credits CME-Credits |
    Pediatric Radiology News / Ads / Jobs Get the Pediatric Radiology News as RSS feed !
    Send us your news or ads for free
  • A Qualitative Comparison of Arterial Spin Labelling and Dynamic Susceptibility Contrast MRI in 52 Ch... (Br J Radiol)
  • Feasibility and Accuracy of Cardiac Right-to-Left-Shunt Detection in Children by New Transpulmonary ... (Pediatr Cardiol)
  • Utility of plain radiographs and MRI in cervical spine clearance in symptomatic non-obtunded pediatr... (Childs Nerv Syst)
  • CME Kurs: Paediatric Body MRI

  • CME course: Paediatric Body MRI

  • Universitätsklinikum Jena sucht eine Ärztin/einen Arzt in Weiterbildung in Vollzeit

  • Kinderspital Zürich sucht Oberärztin / Oberarzt (100 %)

  • Kinderradiologische Oberärztin / Oberarzt gesucht

  • 2 Stellen in der Kinderradiologie - 1 Assistenzärztin/Assistenzarzt und 1 Oberärztin/Oberarzt in Voll- oder Teilzeit

  • Senior Paediatric Radiologist in Pediatric Radiology section needed

  • Facharzt als Oberärztin / Oberarzt in Sektion Kinderradiologie gesucht

  • Stellenangebot für Assistenzarzt (m/w) zur Facharztausbildung für RADIOLOGIE und/oder KINDERRADIOLOGIE

  • „Fellow“-Stelle zur Weiterbildung in Pädiatrischer Radiologie am Kinderspital Zürich

  • Fellow-Stelle Pädiatrische Neuroradiologie

  • FFF Kinderradiologie - Muskuloskelettale Radiologie im Kindesalter (Fit für den Facharzt)

  • Assistenzarzt für Kinderradiologe gesucht an Universitätsklinikum Schleswig-Holstein, Campus Kiel

  • Turnusarzt (m/w) in Ausbildung zum Facharzt (m/w) für Radiologie

  • Assistenzarzt (m/w) zur Weiterbildung im Schwerpunkt Kinderradiologie

  • Send us your news or ads for free

    Get the Pediatric Radiology News as RSS feed !


    Radiolopolis

    The dynamic Radiology community for education, research and practice


     

    Go to the top of the page   ID: 20060104123424 Original case in english  More links about this topic on Pubmed (PubMed Reader)
    Add this case to your RSS feeder: Subscribe to RSS feed Add to Yahoo Add to Google Add to AOL Add to Furl Subscribe to Feed Burner feed

    Bookmark and Share


    | The Authors | Discussion | Write a Comment to this Case |
    | Evaluate this Case | Recommend this Case to a Colleague | Survey Results |
    | Citation | Similar Cases | Similar Cases in the Internet | Images to this Case |
     
    Rapunzel syndrome grade I° due to trichobezoar
    Dirk Schaper, A Jassoy, W Lässig. Rapunzel syndrome grade I° due to trichobezoar. PedRad [serial online] vol 6, no. 1.
    URL: www.PedRad.info/?search=20060104123424


     
     Pediatric Radiology CasesImages to this case: There are MRI-images available for this case. [ MRI ] There are OP-Situs-images available for this case. [ OP-Situs ] There are Pathology-images available for this case. [ Pathology ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Dirk Schaper, A. Jassoy, W. Lässig (Klinik für Kinderchirurgie Krankenhaus St. Elisabeth und St. Barbara Halle und Institut für Radiologie und Klinik für Kinder- und Jugendmedizin Städtisches Krankenhaus Martha-Maria Halle-Dölau gGmbH )  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    14 Years  

     
     Pediatric Radiology CasesGender:

    Female  

     
     Pediatric Radiology CasesRegion-Organ:

    GI-Stomach  

     
     Pediatric Radiology CasesMost likely etiology:

    physical  

     
     Pediatric Radiology CasesHistory:

    In-patient admittance because of reoccuring nausea, vomiting and stomach aches for 6 months. In the pediatrician's office, an epigastric tumor was palpated which was 15 cm in size. The 14 year-old girl was never seriously ill before this, and shows no signs of distress in schoolwork. She has been referred to a dermatologist due to loss of hair.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    Bezoars are conglomerates of undigestable materials like hair (i.e. Hairballs), and are usually located in the stomach. Physiologically, one usually observes this in birds (wool) or in cats. The undigestable left-overs are usually vomited. Bezoars in humans are differentiated due to their make-up. Most common are phytobezoars, which consist of undigestable plant material (cellulose, lignine), the second most common form are trichobezoars, which are usually due to trichophagia (eating of hair) combined with a psychological illness (trichotillomania). Also to the classifications of bezoars are the following: Lactobezoars of premature newborns, the pharmakobezoars due to the clumping of medicinal tablets/capsules. Aside from these four main groups, observations of mixed-types have been made.
    The Rapunzel-Syndrome is when the the bezoar has a "pig-tail" which continues though the gut. This may be observed throughout the entire small intestines and can have an increasingly obstructive effect. Furthermore, gastrointestinal symptoms occur and the bezoar itself.  

     
     Pediatric Radiology CasesRadiological findings:


    MRI 1 <- view MRI 1

    MRI 1: T2-weighted HASTE sequence, coronal.
    Large inhomogeneous, hypointense mass in the T2-weighted image, which fills almost the entire stomach, and continues to the duodenum.






    MRI 2 <- view MRI 2

    MRI 2: T2-weighted HASTE sequence, coronal.
    Large inhomogeneous, hypointense mass in the T2-weighted image, which fills almost the whole stomach, and continues to the duodenum.






    MRI 3 <- view MRI 3

    MRI 3: T2-weighted HASTE sequence, transversal: Here, a large, inhomogeneous, hypointense mass (which has sharp margins), which almost completely fills the stomach. There is distal extension through the pylorus into the duodenum.
    There is a small fluid level to the right and lateral to the mass and air ventral to the mass inside the stomach.




    MRI 4 <- view MRI 4

    MRI 4: T1 weighted 3D-GE-Sequence with fat-saturation and before constrast application. Conspicuous fat saturation in the T1-weighted image, which shows inhomogeneous, hypointense mass in the stomach lumen without evidence of contrast uptake after Gd-DTPA application. Some air in the stomach to the right and lateral of the mass.




    MRI 5 <- view MRI 5

    MRI 5: T1 weighted 3D-GE-Sequence with fat-saturation after contrast application, transversal. Conspicuous fat saturation in the T1-weighted image, which shows an inhomogeneous, hypointense mass in the stomach lumen without evidence of contrast uptake after Gd-DTPA application. Some air in the stomach to the right and lateral of the mass. There is intense contrast uptake in the stomach wall.




    OP-Situs 1 <- view OP-Situs 1

    OP-Situs 1: Specimen





    Pathology 1 <- view Pathology 1

    Pathology 1: Specimen

     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    Surgery / Histo  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    Phytobezoar, Diosphyrobezoar, Pharmacobezoar  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    After diagnostic imaging, initial attempt to reduce the size and removal of the bezoar endoscopically. Because of the size and consistency of the bezoar, it was not possible, and a gastrotomy and removal of the bezoar followed. In this case, this was a trichobezoar with a "pigtail" that reached into the duodenum - about 15 cm in size. The bezoar weighed 1700 grams. After wound healing, the patient was transferred to the clinic for child- and adolescent psychiatry.  

     
     Pediatric Radiology CasesComments of the author about the case:

    In our case, the endoscopic treatment was not possible, so that we decided upon a surgical intervention. In accordance to Alik et al., this was a Rapunzel Syndrome grade I°.  

     
     Pediatric Radiology CasesFirst description / History:

    Bezoars are known since the 12th century, where they were described initially in India. Because of their rarity and the uncertain pathogenesis, bezoars were given magical properties. Even the name, bezoar, comes from the arabic word "Bedzehr" - the persian "Padzahr" - or the hebrew "Beluzaar" - all meaning "opposite material." This, of course, increased the mystical meaning. In the mideval times, bezoars were seen as being valuable, and were even plated in gold. Today, bezoars are more or less a potential medical problem, whose complication rates should not be underestimated.
    Next to the displacement related gastrointestinal symptoms, ileus situations may occur. Furthermore, ulcerations, strangulations and hemorrhages may result and have been described. The name, "Rapunzel Syndrome" was coined by Vaughan et al. in 1968, who referred to the Brothers Grimm fairytale.  

     
     Pediatric Radiology CasesLiterature:

    1. Medline: Medline
    Gockel,I., C.Gaedertz,H.-J.Hain,U.Winckelmann,M.Albani,D.Lorenz
    Das Rapunzel-Syndrom
    Chirurg 2003 74:753-756

    2. Medline: Medline
    M.K.Sanders
    Bezoars: From mystical charms to medical and nutritional management
    Practical Gastroenterology 13 2004

    3. Medline: Medline
    Balik,E.,I.Ulman,C.Taneli,M.Demircan
    The Rapunzel syndrome. A case report and review of the literature
    Eur J Pediatr Surg 3 (1993) 171-173

    4. Medline: Medline
    Vaughan,E.D.,J.L.Sawyers,H,W.Scott
    Rapunzel syndrome: An unusual complication of intestinal bezoar
    Surgery 63: 339-343  

     
     Pediatric Radiology CasesKeywords:

    Bezoar, trichobezoar, hairball, foreign object, stomach, trichophagia, trichotillomania, hair eating, Rapunzel syndrome,, child, childhood, pediatric radiology  

     
     Pediatric Radiology Cases Cite this article:

    Dirk Schaper, A Jassoy, W Lässig. Rapunzel syndrome grade I° due to trichobezoar. PedRad [serial online] vol 6, no. 1.
    URL: www.PedRad.info/?search=20060104123424  

     
     Pediatric Radiology Cases Read similar articles: with corresponding keywords
    in the same field: GI-Stomach
    or in the region: GI
    or in the tissue/organ: Stomach
    or with the etiology: physical
     
     Pediatric Radiology CasesImages to this case: There are MRI-images available for this case. [ MRI ] There are OP-Situs-images available for this case. [ OP-Situs ] There are Pathology-images available for this case. [ Pathology ] View all modalities [ All ]   
     
    Rapunzel syndrome grade I° due to trichobezoar
    Dirk Schaper, A Jassoy, W Lässig. Rapunzel syndrome grade I° due to trichobezoar. PedRad [serial online] vol 6, no. 1.
    URL: www.PedRad.info/?search=20060104123424


     

    Search similar cases in:
    More links about this topic on Pubmed  More links about this topic on Yahoo  More links about this topic on Altavista  More links about this topic on MSN  More links about this topic on Google  More links about this topic on Fireball

    Peer-reviewed Radiology Search



    Rapunzel syndrome grade I° due to trichobezoar
    Other cases by these authors:

    Search Dirk Schaper in Medline Dirk Schaper (43)   
    Search A. Jassoy in Medline A. Jassoy (6)   
    Search W. Lässig in Medline W. Lässig (2)   

    Rapunzel syndrome grade I° due to trichobezoar  
     
    Rapunzel syndrome grade I° due to trichobezoar
    Dirk Schaper, A Jassoy, W Lässig. Rapunzel syndrome grade I° due to trichobezoar. PedRad [serial online] vol 6, no. 1.
    URL: www.PedRad.info/?search=20060104123424


     

    Which diagnosis have other collegues guessed?


    • Gastric carcinoma
      Votes: 0 (0 %)


    • Phytobezoar
      Votes: 0 (0 %)


    • Ascarides
      Votes: 1 (5 %)


    • Trichobezoar
      Votes: 19 (95 %)



        Total answers: 20

     
    Rapunzel syndrome grade I° due to trichobezoar
    Dirk Schaper, A Jassoy, W Lässig. Rapunzel syndrome grade I° due to trichobezoar. PedRad [serial online] vol 6, no. 1.
    URL: www.PedRad.info/?search=20060104123424


     

    Medical Dictionary
    Search in medical dictionary for
    Or type in a keyword
    ( Provided by The On-Line Medical Dictionary )




    How interesting was this case for you?
    (10 = most interesting || 1 = less interesting)
     
    Rapunzel syndrome grade I° due to trichobezoar
    Dirk Schaper, A Jassoy, W Lässig. Rapunzel syndrome grade I° due to trichobezoar. PedRad [serial online] vol 6, no. 1.
    URL: www.PedRad.info/?search=20060104123424


     




    Discussion >> Write Comment <<



      There are no comments available regarding this case.





     Write a comment to this case (With * marked fields have to be filled)

    Type in this number: 7272

    Name: *

    E-Mail:

    Website:

    Subject: *

    Text: *




     
      Pediatric Radiology Discussion Get the Pediatric Radiology Discussion as RSS feed !
      To the discussion forum
      To the discussion forum

      Get the Pediatric Radiology Discussion as RSS feed !

      © 2001-2016   www.kinderradiologie-online.de
      In cooperation with © Radiolopolis - Radiology Search - Radiology Teacher - PubMed Reader - Annotate - Radiology Lectures & Tutorials - Radiology Boards Preparation - Pediatric Radiology Links - Pediatric Radiology Information - Emergency Radiology - Lung Cancers - USMLE Forums - Cancer Staging Information - Chest Radiology - Radiology Case Report Journal
      For suggestions and questions: information@kinderradiologie-online.de
      Add this site to your favorites (CTRL+D)