Rapunzel syndrome leading to acute intestinal obstruction in a teenager: A rare case report

Introduction and importance: Trichobezor is a mass of accumulated ingested hair in the gastric lumen. Rapunzel syndrome is an extension of these bezoars beyond the pylorus. The formation of trichobezoar is invariably linked to trichotillomania and trichophagia. Convergence of trichotillomania and trichophagia resulting in the formation of massive trichobezoar and causing acute intestinal obstruction is a rare clinical manifestation. This case report aims to shed light on diagnostic intricacies and prompt management of such exceptional cases.

Case presentation: This case report features a 13-year-old girl who presented to the surgical emergency department with complaints of abdominal pain, nausea, vomiting, and epigastric fullness for 5-6 months. She also described tufts of hair in vomitus and stools for the past few weeks. Due to these symptoms, she started experiencing significant weight loss, pallor, and pedal edema. Her Investigations revealed a large trichobezoar causing gastrointestinal obstruction and she was managed with exploratory laparotomy and gastrotomy followed by multidisciplinary care.

Clinical discussion: Trichobezoar develops secondary to trichotillomania and trichophagia. These disorders are deeply rooted in psychosocial stressors. This unique presentation highlights the need for awareness regarding such rare causes of intestinal obstruction.

Conclusion: Psychosocial stressors, trichotillomania, and trichophagia often go unnoticed in teenagers resulting in drastic consequences. A multidisciplinary approach is required to diagnose and manage gastrointestinal obstruction secondary to Rapunzel Syndrome.