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

Unusual clinical course, Challenging differential diagnosis, Unusual setting of medical care

Ehsan Sotoudeh, Shabbir Hussain, Omid Shafaat, Houman Sotoudeh

Department of Surgery, Iranian Hospital in Dubai, Dubai, United Arab Emirates

Am J Case Rep 2019; 20:685-688

DOI: 10.12659/AJCR.915517

Available online:

Published: 2019-05-13

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.

Keywords: Bezoars, Fungi, peritonitis