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Successful endovascular treatment of superior mesenteric artery-duodenal fistula secondary to Rapunzel syndrome
Journal article   Open access

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

Assim Saad Eddin, Mohammad Amarneh, Sawyer Goetz and Francesco Donato
Radiology case reports, Vol.18(8), pp.2689-2691
08/01/2023
DOI: 10.1016/j.radcr.2023.05.031
PMCID: PMC10238254
PMID: 37273725
url
https://doi.org/10.1016/j.radcr.2023.05.031View
Published (Version of record) Open Access

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.

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