The Diagnostic Challenge of Rapunzel Syndrome: Multimodal Imaging Findings in a Child

TL;DR

A child with ADHD and a stomach mass was diagnosed with Rapunzel syndrome, showing how imaging and clinical history help in rare cases.

Contribution

This case highlights the multimodal imaging features and diagnostic challenges of Rapunzel syndrome in children with psychiatric conditions.

Findings

Abdominal imaging revealed a large trichobezoar extending into the duodenum.

Endoscopic removal failed, requiring surgical extraction of a 22 cm trichobezoar.

The patient had a history of hair-picking behavior linked to the condition.

Abstract

We report the case of a school-aged patient with attention-deficit/hyperactivity disorder who presented with a palpable epigastric mass. The initial abdominal ultrasonography indicated the presence of a heterogeneous space-occupying lesion in the upper abdomen. Subsequent computed tomography revealed a large intragastric mass with a mottled air-containing density, an imaging feature characteristic of a bezoar. Esophagogastroduodenoscopy confirmed a massive trichobezoar extending beyond the pylorus into the duodenum, consistent with Rapunzel syndrome. Although the endoscopic removal proved unsuccessful, a subsequent surgical extraction via laparotomy yielded a 22 cm trichobezoar. Further history revealed prior hair-picking behavior approximately one year earlier, with a localized bald patch noted by her parents. This case highlights the characteristic multimodal imaging findings of trichobezoars and serves to emphasize the diagnostic challenge posed by a limited clinical history in children with psychiatric comorbidities presenting with abdominal masses.

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