Pediatr Gastroenterol Hepatol Nutr.  2013 Jun;16(2):127-130.

A Case of Rapunzel Syndrome

• Kim JS
• Nam CW

Abstract

Rapunzel syndrome refers to a very rare condition in which swallowed hair forms a gastric trichobezoar that has a long tail extending into the small bowel. We describe a case of Rapunzel syndrome in an 8-year-old girl who presented with abdominal mass, epigastric pain and vomiting. Abdominal computed tomography scan showed a markedly dilated stomach filled with coarse heterogeneous materials. Upper gastrointestinal endoscopy revealed a huge hairy ball with a tail extending through the pylorus. We performed a surgical laparotomy and successfully removed a huge trichobezoar with a long tail extending into the middle portion of jejunum. Psychiatric consultation with review showed her past history of trichotillomania and trichophagia 4 years ago. But her parents denied further psychiatric therapy and she was lost to the follow-up. Rapunzel syndrome should be included in the differential diagnosis in children with chronic abdominal pain and trichophagia.

Keyword

Rapunzel syndrome; Bezoars; Trichotillomania; Trichophagia; Abdominal pain

MeSH Terms

Abdominal Pain
Bezoars
Child
Diagnosis, Differential
Endoscopy, Gastrointestinal
Follow-Up Studies
Hair
Humans
Jejunum
Laparotomy
Parents
Pylorus
Stomach
Trichotillomania
Vomiting

Figure

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  Fig. 1 Abdominal computed tomography scan reveals a huge, free-floating heterogeneous solid mass with mottled gas pattern in the markedly distended stomach.

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  Fig. 2 Upper gastrointestinal endoscopy showing a huge gastric trichobezoar (A) with a tail which extends through the pylorus (B), and the gastric mucosa appears normal without evidence of ulceration.

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  Fig. 3 (A) A very long extension of the hair and trichobezoar is extracted from the stomach through the gastrotomy. (B) A stomach-shaped trichobezoar (measuring 14.0×10.0×5.5 cm and weighing 407 g) with a tail extending into the middle portion of jejunum.

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