Rapunzel syndrome causing partial gastric outlet obstruction requiring emergency laparotomy

Area of Science:

• Gastroenterology
• Pediatric Surgery
• Psychiatry

Background:

• Presents a rare case of trichobezoar formation in a pediatric patient with a history of trichophagia.
• Highlights the potential for trichobezoars to cause significant gastrointestinal complications.

Observation:

• A 16-year-old female presented with acute epigastric pain, anorexia, and vomiting.
• Physical examination revealed a palpable epigastric mass.
• CT scan demonstrated an intragastric trichobezoar extending into the duodenum, indicative of Rapunzel syndrome, with signs of partial gastric outlet obstruction and possible perforation.

Findings:

• Urgent laparotomy confirmed the presence of a large trichobezoar.
• Surgical extraction of the bezoar was performed successfully without intraoperative complications or evidence of perforation.
• The patient experienced an uncomplicated postoperative recovery.

Implications:

• Rapunzel syndrome, though rare, requires prompt surgical intervention to prevent life-threatening complications.
• Emphasizes the importance of psychiatric evaluation and management in patients with trichophagia and bezoar formation.
• Successful surgical outcomes are achievable with timely diagnosis and treatment.