Rapunzel Syndrome—Gossypol Trichobezoar Case Report and Review of Literature

Abstract

Gossypol trichobezoar consists of a compact interwoven mass of hair along with cotton fibers occupying the gastrointestinal tract. When the bezoar extends past the duodenum, it is referred to as Rapunzel syndrome. Trichobezoars are found mostly in females and they may be associated with psychiatric conditions such as trichotillomania and trichophagia. We present a case of a 15-year-old female child presented to our surgical outpatient clinic with palpable mobile epigastric lump and dyspeptic symptoms with early satiety. Imaging studies revealed presence of gastrointestinal foreign body with entangled appearance extending up to ileum. Endoscopy revealed presence of trichobezoar in the stomach extending into the duodenum. The patient underwent laparotomy and anterior oblique gastrotomy, and retrieval of gossypol trichobezoar was done, measuring 102 cm and weighing 500 g. Trichobezoars should be considered as a differential diagnosis in young female patients with epigastric mass. Majority of these patients have an underlying psychiatric disorder. Psychiatric evaluation and counseling is essential to prevent recurrence of the problem.