Gastrointestinal trichobezoars presenting as abdominal pain and obstruction - Rapunzel syndrome

Abstract

Presentation
A 14-year-old female presented to the emergency department with a five-day history of abdominal pain and vomiting. Amylase was raised on admission and she was managed conservatively for presumed acute pancreatitis. Her condition did not improve and she deteriorated a number of days into admission and developed bilious vomiting.

Diagnosis
CT abdomen-pelvis showed trichobezoars in the stomach and duodenum.

Treatment
She underwent emergent laparotomy and manual removal of bezoars in a tertiary centre followed by multi-disciplinary input post-operatively.

Discussion
Atypical abdominal pain in the paediatric population not responding to initial treatment warrants review of diagnosis and further investigation with consideration for early tertiary service input.