Rapunzel syndrome leading to acute intestinal obstruction in a teenager: A rare case report

Trichobezor is a mass of accumulated ingested hair in the gastric lumen. Rapunzel syndrome is an extension of these bezoars beyond the pylorus. The formation of trichobezoar is invariably linked to trichotillomania and trichophagia. Convergence of trichotillomania and trichophagia resulting in the formation of massive trichobezoar and causing acute intestinal obstruction is a rare clinical manifestation. This case report aims to shed light on diagnostic intricacies and prompt management of such exceptional cases. This case report features a 13-year-old girl who presented to the surgical emergency department with complaints of abdominal pain, nausea, vomiting, and epigastric fullness for 5–6 months. She also described tufts of hair in vomitus and stools for the past few weeks. Due to these symptoms, she started experiencing significant weight loss, pallor, and pedal edema. Her Investigations revealed a large trichobezoar causing gastrointestinal obstruction and she was managed with exploratory laparotomy and gastrotomy followed by multidisciplinary care. Trichobezoar develops secondary to trichotillomania and trichophagia. These disorders are deeply rooted in psychosocial stressors. This unique presentation highlights the need for awareness regarding such rare causes of intestinal obstruction. Psychosocial stressors, trichotillomania, and trichophagia often go unnoticed in teenagers resulting in drastic consequences. A multidisciplinary approach is required to diagnose and manage gastrointestinal obstruction secondary to Rapunzel Syndrome. •13-year-old female with recurrent vomiting and epigastric pain diagnosed with trichobezoar.•Diagnosis delayed due to prolonged, nonspecific symptoms, emphasizing the diagnostic challenge of trichobezoar.•Managed successfully with exploratory laparotomy and gastrotomy, showcasing the role of surgery for large trichobezoars.•Discharged in good health after 10 days; follow-up planned with a multidisciplinary team to ensure no recurrence.