Rapunzel syndrome with distal intestinal obstruction secondary to trichobezoar

Abstract

A trichobezoar is an indigestible hair mass in the gastrointestinal tract. It is most common in young women with psychiatric disorders such as trichotillomania and trichophagia. We present the case of a 16-year-old otherwise healthy female patient without a prior history of psychiatric disorders who consulted for abdominal pain lasting one week, associated with vomiting and intolerance to oral feeding.
On physical examination, there was evidence of alopecia, and a palpable mass was noted in the epigastric region. The computed tomography scan revealed an image suggestive of a gastric trichobezoar occupying the entire stomach and extending into the duodenum, consistent with Rapunzel syndrome. The mass was extracted via laparotomy with gastrotomy, and an enterotomy was performed due to the presence of trichobezoars in the distal ileum. The postoperative period was uneventful, and the patient was discharged on postoperative day 5.This case highlights the importance of considering this diagnosis in patients with gastrointestinal symptoms and alopecia, without a prior history of psychiatric disorders.