A Case of Rapunzel Syndrome With Multiple Trichobezoars Causing Intestinal Obstructions

Abstract

Rapunzel syndrome is a condition in which a trichobezoar, formed by hair ingestion, extends beyond the duodenum, and is often observed in young females, sometimes leading to intestinal obstruction. Herein, we report a case of Rapunzel syndrome presenting with multiple trichobezoars causing intestinal obstruction. An 11-year-old girl presented with complaints of abdominal pain and vomiting. Contrast-enhanced abdominal computed tomography (CT) revealed a heterogeneous, reticular mesh-like structure extending from the stomach into the duodenum, along with similar structures causing small bowel obstruction. A history of trichotillomania and pica was noted over the past year, leading to a diagnosis of Rapunzel syndrome with intestinal obstruction due to trichobezoars. The patient underwent a midline upper abdominal incision, followed by gastrotomy, during which a wound retractor was inserted. After removing the gastric trichobezoar, the gastrotomy site was temporarily closed. A balloon catheter was then introduced through the duodenal side to mobilize two additional trichobezoars located in the small intestine, which were successfully extracted. As trichobezoars can occasionally cause small bowel obstruction, careful evaluation for additional hair masses within the small intestine is essential.