Case Of The Month

January 22, 2008 Diagnostic Imaging. Case Of The Month Pooja Voria, M.D., MBA, Irini Youseff, M.D., MPH, and Robert Perone, M.D. -------------------------------------------------------------------------------- Clinical History A 13-year-old girl presents with abdominal pain, right lower quadrant tenderness, guarding, elevated lipase, and a history of gastroesophageal reflux disease. Findings On contrast-enhanced CT images, a heterogeneous low-attenuation intraluminal mass is identified in the stomach (Figure 1), duodenum, and jejunum (Figure 2). Multiple intussusceptions are seen in several segments of the small bowel demonstrating mesenteric fat separating the intussusceptum from the intussuscipiens. Diagnosis Rapunzel syndrome. Differential Diagnosis The top differential diagnosis includes gastric carcinoma, postprandial food, and intramural mass. Discussion A bezoar is a ball of ingested foreign material that collects in the lumen of the gastrointestinal tract. Foreign materials, such as hair, plastic, paper, string, cotton, and prune pits, fail to pass through the pylorus and small intestine. The most common bezoar in a child is a hairball, or trichobezoar. Rapunzel's syndrome occurs when the main portion of the trichobezoar is located in the stomach with extension of the tail into the small bowel and/or right colon.

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