Gastric trichobezoar with small bowel extension (Rapunzel syndrome): A case report

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Rapunzel syndrome is a rare complication of trichobezoar in which a gastric hair mass extends into the small intestine, predominantly affecting young females with behavioural or psychiatric disorders. An 18-year-old female with a known history of trichobezoar presented with complaints of abdominal pain accompanied by repeated vomiting. Laboratory evaluation, upper gastrointestinal endoscopy and contrast-enhanced computed tomography of the abdomen were performed to establish the diagnosis. Laboratory evaluation revealed leucocytosis and elevated inflammatory markers. Upper gastrointestinal endoscopy identified a large intragastric trichobezoar. Contrast-enhanced computed tomography demonstrated heterogeneous mottled gas-containing lesions involving the stomach and duodenum, associated with loculated ascites and mesenteric fat stranding, consistent with Rapunzel syndrome. The patient underwent exploratory laparotomy with gastrotomy, resulting in the complete removal of the gastric trichobezoar with intestinal extension. Post-operative recovery was uneventful under standardised medical management. A psychiatric consultation was arranged before discharge to address behavioural risk factors and reduce the likelihood of recurrence. The case emphasises the need for the diagnostic value of combined imaging and endoscopy and highlights the importance of a multidisciplinary approach for optimal management and prevention of recurrence in Rapunzel syndrome.