A Case of Rapunzel Syndrome
An 8-year-old girl was referred to our pediatric clinic with a 3-month history of palpable abdominal mass, epigastric pain, and intermittent vomiting that worsened after meals. Her mother reported several episodes of vomiting, which consisted of undigested recently eaten food. There was no history of recent illness, fever, diarrhea, or ingestion of toxic substances. Physical examination of her abdomen revealed hyperactive bowel sounds and a palpable firm mass in the epigastric region (approximately 15×10 cm). No acute peritoneal signs were evident. The patient had long hair, and no erythema, scaling, or scalp edema was present. The rest of the physical examination was unremarkable.\nLaboratory findings were all within normal limits, including complete blood cell counts, serum electrolyte levels, liver and renal function tests, complete metabolic panel, and pancreatic enzyme levels. Plain radiograph of the abdomen revealed an unusual gas pattern in the left upper quadrant with a rim of air inside. Abdominal computed tomography (CT) scan revealed a huge free-floating heterogeneous solid mass with a mottled gas pattern in the markedly distended stomach (). The diagnosis of gastric trichobezoar was made, and removal through an upper gastrointestinal endoscopy was considered. Upper gastroscopy revealed a huge gastric trichobezoar mixed with undigested food material occupying almost the entire gastric cavity. A long hairy tail was exiting the pylorus and extending into the duodenal bulb; the gastric mucosa appeared normal without evidence of ulceration (). An attempt to remove the trichobezoar using foreign body forceps failed because of its extensive size. Consequently, surgical laparotomy was performed. A gastrostomy was made in the anterior wall of the stomach, and the huge trichobezoar was subsequently identified and extracted. The stomach-shaped mass measured 14.0×10.0×5.5 cm, weighed 407 g, and had a long tail of hair extending through the pylorus into the middle portion of the jejunum ().\nThe patient had an uneventful postoperative course and was discharged and returned home 7 days later. During her admission, a psychiatric consultation with a review revealed a history of trichotillomania and trichophagia 4 years ago. However, we failed to find the fundamental causes of stress or anxiety disorder associated with her trichotillomania and trichophagia. Her parents were advised to visit a pediatric psychiatrist for further psychiatric intervention. However, they refused further psychiatric treatment, and the patient was lost to follow-up.