Successful endovascular treatment of superior mesenteric artery-duodenal fistula secondary to Rapunzel syndrome

Assim Saad Eddin; Mohammad Amarneh; Sawyer Goetz; Francesco Donato Jr

doi:10.1016/j.radcr.2023.05.031

Successful endovascular treatment of superior mesenteric artery-duodenal fistula secondary to Rapunzel syndrome

Radiol Case Rep. 2023 May 31;18(8):2689-2691. doi: 10.1016/j.radcr.2023.05.031. eCollection 2023 Aug.

Authors

Assim Saad Eddin¹, Mohammad Amarneh², Sawyer Goetz³, Francesco Donato Jr²

Affiliations

¹ Department of Radiology, University of Iowa Hospitals and Clinics, 738 Mission Point Rd, Iowa City, IA, 52242, USA.
² Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
³ Department of Radiology, Carver College of Medicine, Iowa City, IA, USA.

Abstract

Rapunzel syndrome is a rare clinical entity in pediatric patients with a history of trichotillomania and trichophagia that has only been mentioned a few times in the literature. It is characterized by abnormal gastric bezoar formation that sometimes extends to the duodenum, jejunum, or colon. Here, we present a case of a 16-year-old previously healthy female patient who had prolonged hospitalization due to complications related to a significant gastric bezoar that led to massive bleeding due to a superior mesenteric artery (SMA)-duodenal fistula successfully treated with stent graft placement. Undiagnosed trichobezoar can lead to rare and unexpected complications, such as SMA-duodenal fistula, with life-threatening hemorrhagic shock. Prompt activation of massive transfusion protocol and endovascular control of the hemorrhage was vital to successfully treating our patient.

Keywords: Endovascular treatment; Hemorrhagic shock; Pediatric patients; Rapunzel Syndrome; Sma-duodenal fistula; Trichobezoar.

Publication types

Case Reports