Gastrointestinal obstruction secondary to Rapunzel syndrome: A case report and review of the literature

Rapunzel syndrome is an extremely rare and complex manifestation of a gastric trichobezoar, characterized by a hairball mass that extends from the stomach into the small intestine. This report details a unique case of a 30-year-old female with cerebral palsy who presented with a five-month history of vomiting, a progressive decrease in oral intake leading to an inability to feed by mouth, and significant weight loss. Physical examination revealed diffuse alopecia, clinical signs of malnutrition, and a firm, mobile epigastric mass. Diagnostic imaging through computed tomography (CT) identified a large intraluminal mass extending from the gastric lumen into the jejunum, resulting in mechanical obstruction. While endoscopy visualized the mass, its significant size precluded endoscopic retrieval. Consequently, the patient underwent an exploratory laparotomy and longitudinal gastrotomy for successful extraction. The postoperative recovery was uncomplicated, and a four month follow-up demonstrated a complete resolution of symptoms and significant weight gain. In conclusion, the early clinical suspicion of Rapunzel syndrome is vital in patients with underlying psychiatric conditions or neurological impairments, to prevent life-threatening complications and ensure timely surgical intervention. In addition to the case presentation, this paper provides a review of the literature.