Published: 2019-08-28

Rapunzel syndrome trichobezoar in a twelve year old girl: a case report

Dharmendra Kumar Pipal, Vibha Pipal, Rajendra Pipal, Seema Yadav, Saurabh Kothari


A bezoar refers to a mass of undigestible foreign material found in the gastrointestinal tract, mainly stomach. The second most common bezoar is the trichobezoar, which usually occurs in the young psychiatric female patients with history of trichotillomania and trichophagia. A 12-year-old female psychiatric patient came with complains of diffuse abdominal pain, vomiting, fever, and constipation. Ultrasonography and CT scan were done, which suggested trichobezoar. Thus, trichobezoar should be considered as differential diagnosis of abdominal pain in young psychiatric female patients. In the literature several treatment options are proposed, including removal by conventional laparotomy, laparoscopy and endoscopy. According to our experience and in line with the published results, conventional laparotomy is still the treatment of choice. In addition, psychiatric consultation is necessary to prevent relapses. We here report a case of 12 years old girl presented with complain of vomiting, pain and lump abdomen, loss of appetite and on laprotomy a large, approximately 156 cm trichobezoar was removed which was extending from stomach to ileocaecal junction. Trichobezoar, an underdiagnosed entity, has to be considered in the differential diagnosis of abdominal pain and a non-tender abdominal mass even in young children.


Trichobezoar, Rapunzel syndrome, Psychiatric female

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Vaughan ED, Sawyers JL, Scott HW. The Rapunzel syndrome: an unusual complication of intestinal bezoar. Surg. 1968;63:339-43.

Ellabban GM, Saber A, Ellabban A. A large Gastric trichobezoar in a 21-year- old girl: a case report. Case Study Case Rep. 2011;1(1): 41-4.

Debakey M, Oschner A. Bezoars and concretions: Comprehensive review of literature with analysis of 303 collected cases and presetitations of 8 additional cases. Surg. 1939;5:132-60.

Gonuguntla V, Joshi D. Rapunzel Syndrome. A comprehensive review of an unusual case of trichobezoar. Clin Med Res. 2009;7:99-102.

Gupta NS, Naik S, Chaudhary AK, Jain P, Sharma A. Rapunzel syndrome reviewed and redefined. Dig Surg. 2007;24:157-61.

Dalshaug GB, Wainer S, Hollaar GL. The Rapunzel syndrome (trichobezoar) causing atypical intussusception in a child: a case report. J Pediatr Surg. 1999;34(3):479-80.

Sharma Y, Chhetri RK, Makaju RK, Chapagain S, Shrestha R. Epigastric mass in a young girl: trichobezoar. Imaging diagnosis. Nepal Med Coll J. 2006;8:211-2.

John NP, Timothy JU. Stomach and duodenum. In: Williams NS, Bulstrode CJK, O’Connell PR. eds. Bailey and Love’s Short Practice of Surgery. 26th ed. Boca Raton, FL: CRC Press; 2013: 1023-1057.

Salaam K, Carr J, Grewal H, Sholevar E, Baron D. Untreated trichotillomania and trichophagia: surgical emergency in a teenage girl. Psychosomat. 2005;46:362-6.

Coulter R, Antony MT, Bhuta P, Memon MA. Large gastric trichobezoar in a normal healthy woman: case report and review of pertinent literature. South Med J. 2005;98:1042-4.