Huge gastric trichobezoar causing intestinal obstruction in an adolescent girl: a case report and review of the literature

Introduction: Trichobezoars are rare but significant causes of gastrointestinal obstruction in children, most commonly confined to the stomach. In certain cases, these bezoars can grow large enough to extend into the duodenum, resulting in severe gastrointestinal complications. Case presentation: A previously healthy 16-year-old female presented with an 8-hour history of nausea, vomiting, and diarrhea. Physical examination revealed a palpable mass in the epigastric and left hypochondriac regions. Paraclinical investigations, including laboratory tests and imaging, yielded no significant abnormalities. The patient subsequently underwent emergent exploratory laparotomy, which identified a large trichobezoar. An anterior gastrotomy was performed, and the bezoar was successfully removed in one piece. The postoperative course was uneventful, and the patient was discharged on postoperative day 17, after tolerating a regular diet. She was referred for psychiatric evaluation to address underlying trichotillomania and trichophagia, with the goal of preventing recurrence. Discussion: Rapunzel syndrome predominantly affects young females with underlying psychiatric conditions. Delayed diagnosis is common, often leading to serious gastrointestinal complications, including perforation, infections, cholangitis, obstructive jaundice, intussusception, and pancreatitis. Early detection and intervention are crucial to prevent these potentially life-threatening outcomes. Surgical removal through gastrotomy is typically required, particularly for large bezoars. Conclusion: Trichobezoars, though rare, present serious health risks when left untreated, especially in pediatric patients with underlying psychiatric disorders like trichotillomania and trichophagia. Prompt diagnosis and intervention, including surgical removal, are essential to avoid severe complications. This highlights the importance of early recognition and multidisciplinary care in managing trichobezoar-related gastrointestinal complications.