Rapunzel syndrome: Surgical problem in a neuropsychiatric disorder

Abstract

The Rapunzel syndrome is an extreme form of trichobezoar found in patients with a history of psychiatric disorders, like trichotillomania (habit of hair pulling) and trichophagia (morbid habit of chewing the hair). The signs and symptoms are nonspecific and include vomiting, early satiety, abdominal pain, abdominal mass, and weight loss. Diagnosis can be established with a thorough history combined with radiography and endoscopy with high index of suspicion. Treatment options include combination of laparoscopy and/or laparotomy with long-term psychiatric treatment and monitoring. We report the case of an 17-year-old female, who presented with an abdominal pain, fullness after meals, nausea, vomiting and significant weight loss due to a trichobezoar with a long, 130 cm tail into the small bowel. The patient had an uneventful postoperative outcome after laparotomy and removal of trichobezoar.