In the literature of the world on this topic there is not another report of this syndrome in a pregnant woman. Consequently, there is no consensus agreement, proposal or recommendation for the therapeutic approach for these patients. However, given the need for extraction and the existing experience which has been reported for laparoscopies for pregnant women, laparoscopy is considered to be the ideal approach for these patients, although this also depends on the months of pregnancy and associated diseases peculiar to each patient. 1. Goswin Yason Meyer-Rochow, Bernd Grunewald. Laparoscopic Removal of a Gastric Trichobezoar in a Pregnant Woman. Surg Laparosc Endosc Percutan Tech 2007; 172: 129-132. 2. Puja Mehta, Rajinder Bhutiani. The Rapunzel syndrome: is it an Asian problem? Case report and review of literature European Journal of Gastroenterology & Hepatology 2009, 218: 937-940. 3. Mohamed Salem, Ragai Fouda, Usama Fouda, Mohamed EL Maadawy, Hussam Ammar. Rapunzel and Pregnancy. Southern Medical Journal 2009; 1021: 106-107. 4. Samer B Shami, Ayatallah AM, Jararaa, Aymman Hamade, Basil J, Ammori. Laparoscopic Removal of a huge Gastrc Tricobezoar in a patient with Trichotillommaia. Surg laparosc Percutan tech 2007; 173: 197-200. 5. Doron Zamir, Carl Goldblum, Lina Linova, Ilia Polychuck, Tatiana Reitblat, Boris Yoffe, Rothman M. Phytobezoars and Trichobezoars A 10-Year Experience. J Clin Gastroenterol 2004; 3810: 873-876. 6. Sánchez Vallejo Gregorio, Osorio Correa Eisner, Barrera Lopez Ana. Cuerpos extraños en tracto gastrointestinal asociados a trastorno mental. Reporte de caso. Rev Col Gastroentero 2009; 241: 79-85. 7. Deslypere JP, praet M, Verdonk G. An unusual Case of the trichobezoar: the Rapunzel syndrome. Am J Gastroenterol 1982; 77 7: 467-70. 9. Vaughan ED Jr, Sawyers JL, Scott HW Jr. The Rapunzel syndrome: an unusual complication of intestinal bezoar. Surgery 1968; 63: 339-343. 11. Rojas Elsa. Manual de urgencias en medicina interna. Ediciones Acta Médica Colombiana. Servicio de gastroenterología. Hospital San Juan de Dios, Bogotá. 12. Rider JA, Foresti LF, Garrido J, et al. Gastric bezoars: treatment and prevention. Am J Gastroenterol 1984; 79: 357-359. 13. Klamer TW, Max MH. Recurrent gastric bezoars: a new approach to treatment and prevention. Am J Surg. 1983; 145: 417-419. 14. Ripolles T, García-Aguayo J, Martínez MJ, Gil P. Gastrointestinal bezoars: sonographic and CT characteristics. AJR Am J Roentgenol 2001; 177: 65-69.
Dada las escasez de reportes y aunque en la literatura mundial ya existe otro informe de este síndrome en paciente embarazada, no existe consenso ni recomendación ni propuesta alguna acerca del enfoque terapéutico en estos pacientes; sin embargo, dada la necesidad de extracción y la ya existente experiencia reportada con laparoscopia en mujeres embarazadas se considera este el abordaje ideal para estas pacientes, eso sí dependiendo de los meses de gestación y las comorbilidades propias de cada una.