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Case Reports
. 2019 May 13:20:685-688.
doi: 10.12659/AJCR.915517.

Fungal Peritonitis with Fungus Balls, a Complication of Trichobezoars and Rapunzel Syndrome

Ehsan Sotoudeh  1 , Shabbir Hussain  2 , Omid Shafaat  3 , Houman Sotoudeh  4
Affiliations
Case Reports

Fungal Peritonitis with Fungus Balls, a Complication of Trichobezoars and Rapunzel Syndrome

Ehsan Sotoudeh et al. Am J Case Rep. .

Abstract

BACKGROUND Rapunzel syndrome is a rare condition involving the extension of bezoars from the stomach to the distal gastrointestinal tract. Laparotomy remains the gold standard treatment for this condition because of the size of the bezoars. Although bacterial peritonitis is a known complication of laparotomy in Rapunzel syndrome, very few cases of post-surgical fungal peritonitis have been reported in these patients. CASE REPORT In this case report we present Rapunzel syndrome complicated by post-surgical fungal peritonitis and formation of fungus balls. To our knowledge, fungal peritonitis with fungus balls has never been reported as a Rapunzel syndrome complication. CONCLUSIONS It is important to cover Candida and other fungi with an antifungal regimen in pediatric patients with Rapunzel syndrome pre- and post-surgery. In addition, prolonged fever and septic symptoms post-surgery warrant a search for peritoneal fungus balls that are not simply responsive to anti-fungal therapy and may necessitate repeat laparotomy.

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Conflict of interest statement

Conflict of interest: None declared

Conflict of Interest

None.

Figures

Figure 1.
Figure 1.
Coronal abdominal computed tomography shows distended stomach with a large bezoar (A). The removed trichobezoar from the stomach (B).
Figure 2.
Figure 2.
Images during the second laparotomy demonstrate white nodules over the anti-mesenteric surface of small bowel (arrows) which were proven to be fungus balls on subsequent fungal smear.
See this image and copyright information in PMC

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