Rapunzel syndrome associated with giant trichobezoar in a patient with a history of trichotillomania: case report

Abstract

We present the clinical case of an 18-year-old female patient with a personal history of onychophagia, trichophagia, trichotillomania and anxiety disorder with poor adherence to treatment. She presented at the Emergency Department with clinical data compatible with intestinal obstruction at the gastric level with presence of an abdominal mass in the upper quadrant accompanied with a three-day history of abdominal pain, vomit and absence of bowel movements. A simple abdominal tomography was performed, showing gastric outlet obstruction with material suggestive of bezoar and small bowel dilatation. An urgent laparotomy was performed finding a giant trichobezoar with measurements of 30x12x6 centimeters. Patients affected by trichobezoars usually remain asymptomatic for many years and the onset of symptoms is insidious. The most associated symptoms include abdominal pain, nausea, vomiting, early satiety, anorexia and weight loss, as well as clinical data compatible with gastric obstruction. Trichobezoar is an extremely rare entity, with an incidence of less than 0.3% of the general population, occurring almost exclusively in female patients with a history of trichotillomania.