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

Patient: Female, 7 Final Diagnosis: Rapunzel syndrome Symptoms: Abdominal pain Medication: — Clinical Procedure: Laparatomy Specialty: Surgery OBJECTIVE: Unusual clinical course 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 a case of 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 in the English literature 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.