# Rapunzel Syndrome in a Pediatric Female Patient: A Case Report of Trichobezoar Causing Intestinal Obstruction

## TL;DR

A six-year-old girl with no psychiatric history was diagnosed with Rapunzel syndrome, a rare condition involving a hair mass causing intestinal blockage, highlighting the need for early recognition in children.

## Contribution

This case report increases awareness of Rapunzel syndrome in children without psychiatric backgrounds and emphasizes early diagnosis and treatment.

## Key findings

- A six-year-old girl was diagnosed with Rapunzel syndrome despite having no psychiatric history.
- Endoscopic removal of the trichobezoar failed, requiring surgical intervention.
- The case underscores the importance of early recognition to prevent complications.

## Abstract

Rapunzel syndrome is a very rare type of trichobezoar in which a hair mass extends to the stomach and small intestine forming a body and tail. It usually affects young females with a psychiatric background. Symptoms are usually nonspecific and often delay the diagnosis.

We present in this report a case of a six-year-old previously healthy girl who presented with two months of intermittent abdominal pain, vomiting, and constipation. Initial laboratory tests and two times abdominal ultrasounds were unremarkable. Abdominal X-ray showed moderate dilatation of the bowel. Further physical examination revealed patchy scalp alopecia, raising suspicion for hair ingestion. Upper endoscopy showed a large trichobezoar in the stomach and duodenum, but endoscopic removal failed. The patient underwent open laparotomy, and an 11 × 4 cm bezoar with a tail extending into the duodenum was removed.

This case highlights the value of recognizing Rapunzel syndrome in children with vague gastrointestinal symptoms, even without a prior psychiatric history. Early recognition and management, including surgical and non-surgical interventions, are important to prevent complications and recurrence.

The study aims to describe a rare presentation of Rapunzel syndrome in order to increase awareness among physicians and emphasize the importance of early recognition and treatment to prevent serious complications.