Rapunzel syndrome: Case report of a giant trichobezoar in pediatrics

Abstract

Introduction: Trichobezoar is a mass formed mainly by human hair, among other fibers or materials that affect the gastrointestinal system in patients with a history of trichotillomania and trichophagia; the manifestations are non-specific, including satiety, anorexia, vomiting, abdominal pain, one of the complications of Rapunzel syndrome, which is characterized by the presence of a trichobezoar located in the stomach with a tail that extends beyond the pylorus and is the cause of intestinal obstruction. Case description: A 10-year-old female with a history of undiagnosed trichotillomania and trichophagia, in addition, a history of recurrent chronic abdominal pain, progressive loss of appetite, and weight loss. Upon admission, he presented with post-ingestion vomiting and abdominal distension. Physical examination: vital signs without alterations, very low weight for age, presence of alopecia at the right frontotemporal level, abdomen with a mass in the epigastrium. Laboratory studies without alterations. Endoscopy and esophagogastroduodenal series report the presence of a bezoar in the stomach. Laparotomy describes a trichobezoar that covered the entire gastric chamber and extended to the duodenum, causing obstruction, thus confirming the diagnosis of Rapunzel syndrome. Management included nutritional and psychiatric support for trichotillomania and trichophagia secondary to generalized anxiety disorder. Conclusion: The clinical characteristics of this case correspond to what has been described in the literature by other authors, trichobezoar should be considered as a differential diagnosis in adolescent women with a history or suspicion of trichotillomania and/or trichophagia who present with abdominal pain.