Trichobezoar presenting as a gastric outlet obstruction: A case report

Area of Science:

• Gastroenterology
• Pediatric Surgery

Background:

• Rapunzel syndrome is a rare intestinal condition characterized by trichobezoars, predominantly affecting females.
• It is often associated with trichotillomania (hair pulling) and trichophagia (hair eating).
• Fewer than 40 cases are documented, with psychological treatment emphasized for recurrence prevention.

Purpose of the Study:

• To highlight a rare case of Rapunzel syndrome presenting as gastric outlet obstruction.
• To emphasize the importance of considering this diagnosis in pediatric patients with relevant history and symptoms.

Main Methods:

• Case report of a 7-year-old girl with a history of trichotillomania and trichophagia.
• Presentation with symptoms of gastric outlet obstruction (abdominal pain, nausea, vomiting).
• Surgical intervention via exploratory laparotomy and gastrostomy to remove a large trichobezoar.

Main Results:

• A large 18cm x 18cm trichobezoar was discovered, extending into the small bowel.
• The trichobezoar caused significant gastric outlet obstruction.
• Surgical removal was necessary due to the substantial size of the bezoar.

Conclusions:

• Bezoars, though rare, can cause severe gastrointestinal obstructions.
• Rapunzel syndrome should be considered in the differential diagnosis of gastric outlet obstruction in young females.
• Surgical intervention is often required for large trichobezoars, as minimally invasive techniques may be insufficient.