# 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.

## Key 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.