Clinical Report: Rapunzel Syndrome Masks Weight Loss

Overview

This report details a case of Rapunzel syndrome in a 10-year-old girl presenting with significant weight loss, abdominal pain, and anxiety surrounding eating. Surgical intervention successfully removed a large trichobezoar, leading to resolution of symptoms and improved weight status, highlighting the need for psychiatric evaluation.

Background

Rapunzel syndrome is a rare but serious condition characterized by the formation of a trichobezoar, a mass of ingested hair, that can lead to gastrointestinal obstruction or perforation. Early recognition and intervention are crucial, especially in pediatric patients who may present with nonspecific symptoms such as weight loss and abdominal pain. Understanding the psychiatric underpinnings, such as trichotillomania and trichophagia, is essential for effective management, particularly in patients with a history of psychiatric disorders.

Data Highlights

No numerical data available in the source material, but the case's clinical significance is evident.

Key Findings

• A 10-year-old girl presented with 8 months of progressive weight loss and abdominal pain, alongside anxiety related to eating.
• Initial imaging was inconclusive, but MRI revealed a large intragastric filling defect consistent with a trichobezoar.
• Surgical exploration confirmed a large trichobezoar extending through the pylorus.
• Postoperative management included gradual reintroduction of oral feeding, behavioral therapy, and addressing underlying psychiatric conditions.
• At 3-month follow-up, the patient's weight improved significantly, and abdominal symptoms resolved.
• Rapunzel syndrome should be considered in pediatric patients with unexplained weight loss, even without classic psychiatric features.

Clinical Implications

Clinicians should maintain a high index of suspicion for Rapunzel syndrome in pediatric patients presenting with unexplained weight loss and gastrointestinal symptoms. Early surgical intervention and multidisciplinary care, including psychiatric support, are essential for optimal outcomes, particularly in patients with underlying psychiatric conditions.

Conclusion

Rapunzel syndrome is a critical diagnosis to consider in children with weight loss and abdominal pain. Timely surgical intervention can lead to significant improvements in health and well-being.

References

1. Lurshay RM, et al., Cureus, 2023 -- Rapunzel Syndrome Masks Weight Loss
2. the new gastroenterologist, 2026 -- Rapunzel syndrome: A rare but important cause of pediatric weight loss
3. Gastrointestinal trichobezoars in the pediatric population: a retrospective study - PMC
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6. The Journal of Clinical Endocrinology & Metabolism — Circulating DLK1 Levels in Healthy Girls and Those With Precocious Puberty During Minipuberty and Pubertal Development
7. Gastrointestinal trichobezoars in the pediatric population: a retrospective study - PMC
8. Official journal of the American College of Gastroenterology | ACG