GASTRIC TRICHOBEZOAR IN A 10-YEAR-OLD FEMALE PATIENT AS AN UNCOMMON CAUSE OF UPPER GASTROINTESTINAL TRACT OBSTRUCTION: CASE REPORT
Keywords:
trichobezoar; Rapunzel syndrome; gastric outlet obstruction; pediatric; trichotillomania; trichophagiaAbstract
DOI: https://doi.org/10.46296/gt.v9i18.0390
Abstract
Background: Gastric trichobezoar is an uncommon but clinically important cause of upper gastrointestinal obstruction in children, especially girls and adolescents. Objective: To synthesize contemporary evidence on presentation, diagnostic work-up, treatment and outcomes of pediatric gastric trichobezoars, emphasizing obstructive presentations and 10-year-old girls. Methods: Systematic review of pediatric case reports, case series and descriptive cohorts. PubMed/MEDLINE was searched through August 31, 2026, using terms related to trichobezoar, Rapunzel syndrome, pediatric age and obstruction. PRISMA 2020 principles were followed and JBI case-report/case-series domains informed appraisal. Meta-analysis was not undertaken because of clinical heterogeneity. Results: The focused contemporary search retrieved 71 records. Across the clinically relevant literature, girls predominated. Abdominal/epigastric pain, vomiting, early satiety or anorexia, weight loss and a palpable epigastric mass were recurring features. Computed tomography and upper endoscopy provided the most useful confirmation and delineation of extension. Large compact bezoars and Rapunzel syndrome were most often managed by gastrotomy, whereas endoscopic or minimally invasive removal was feasible only in selected cases. Reported complications included bleeding, pancreatitis, intussusception, perforation and intestinal obstruction. Psychiatric or psychological follow-up was repeatedly emphasized to prevent recurrence. Conclusion: Trichobezoar should be considered early in a 10-year-old girl with persistent vomiting, early satiety, weight loss and an epigastric mass. Cross-sectional imaging/endoscopy define extent, large lesions usually need surgical extraction, and behavioral follow-up is integral to definitive care.
Keywords: trichobezoar; Rapunzel syndrome; gastric outlet obstruction; pediatric; trichotillomania; trichophagia.
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Gorter RR, Kneepkens CMF, Mattens ECJL, Aronson DC, Heij HA. Management of trichobezoar: case report and literature review. Pediatr Surg Int. 2010;26(5):457-463. doi:10.1007/s00383-010-2570-0.
Leonhardt J, et al. Do Paediatric Patients with a Trichobezoar Benefit from a Modified Laparoscopic Approach? A Systematic Review. Klin Padiatr. 2026 Apr 15. doi:10.1055/a-2833-9457.
Malik H, et al. Rapunzel syndrome causing partial gastric outlet obstruction requiring emergency laparotomy. BMJ Case Rep. 2020;13(1):e232904. doi:10.1136/bcr-2019-232904.
Gonuguntla V, Joshi DD. Rapunzel syndrome: a comprehensive review of an unusual case of trichobezoar. Clin Med Res. 2009;7(3):99-102. doi:10.3121/cmr.2009.822.
Derzsi Z, et al. Rapunzel Syndrome—An Extremely Rare Cause of Digestive Symptoms in Children: A Case Report and a Review of the Literature. Front Pediatr. 2021;9:684379. doi:10.3389/fped.2021.684379.
Nouri A, et al. Management of trichobezoar: About 6 cases. Afr J Paediatr Surg. 2022;19(2):102-104. doi:10.4103/ajps.AJPS_110_20.
Chaudhary MA, et al. Gastric Trichobezoars in paediatric population—A series of six cases and literature review. Ann Med Surg (Lond). 2022;84:104906. doi:10.1016/j.amsu.2022.104906.
Kotilea K, et al. Gastric Trichobezoars in Children and Adolescents: A Single-Center Case Series. Acta Gastroenterol Belg. 2026;89(2):413-418. doi:10.51821/89.2.15484.
Park J, et al. Treatment of large gastric trichobezoar in children: Two case reports and literature review. Medicine (Baltimore). 2023;102(16):e33589. doi:10.1097/MD.0000000000033589.
Ono W, et al. Successful endoscopic treatment of a huge trichobezoar in a 10-year-old girl. DEN Open. 2024;4(1):e357. doi:10.1002/deo2.357.
Yousufzai S, et al. A giant trichobezoar in a child with attention deficit hyperactivity disorder: A case report. Int J Surg Case Rep. 2024;123:110283. doi:10.1016/j.ijscr.2024.110283.
Horoub R, et al. Gastric trichobezoars in two pediatric girls: A case report. Int J Surg Case Rep. 2025;133:111590. doi:10.1016/j.ijscr.2025.111590.
Hida M, et al. Rapunzel syndrome complicated with pancreatitis, intussusception and intestinal perforation. BMJ Case Rep. 2022;15(7):e247005. doi:10.1136/bcr-2021-247005.
Trapani S, et al. An Unusual Case of Hypoproteinemia in Childhood: Keep in Mind Trichobezoar. Front Pediatr. 2020;8:82. doi:10.3389/fped.2020.00082.
Mahmod J, et al. Trichobezoar as an Unusual Cause for Iron Deficiency Anemia: A Rare Case Report. Clin Case Rep. 2025;13(2):e70186. doi:10.1002/ccr3.70186.
Jiledar, et al. Gastric perforation secondary to recurrent trichobezoar. Indian J Pediatr. 1996;63(5):689-691. doi:10.1007/BF02730823.
De Backer A, et al. Huge gastric trichobezoar in a 10-year-old girl. J Pediatr Gastroenterol Nutr. 1999;28(5):513-515. doi:10.1097/00005176-199905000-00015.
Nassar I, et al. Trichobezoar: A Rare Cause of Gastric Obstruction. Glob Pediatr Health. 2023;10:2333794X231165171. doi:10.1177/2333794X231165171.
Weng SC, et al. The Diagnostic Challenge of Rapunzel Syndrome: Multimodal Imaging Findings in a Child. Diagnostics (Basel). 2026;16(6):940. doi:10.3390/diagnostics16060940.
Ji F, et al. Endoscopic removal of a massive trichobezoar in a pediatric patient by using a variceal ligator cap: A case report and literature review. Front Med (Lausanne). 2022;9:1020648. doi:10.3389/fmed.2022.1020648.
Akiyama N, et al. Trichobezoar effectively treated with direct endoscopic injection of Coca-Cola: A case report. DEN Open. 2024;4(1):e283. doi:10.1002/deo2.283.
Hayashi A, et al. Laparoscopic removal of massive pediatric gastric trichobezoars: A brief report. Am J Surg. 2020;219(5):810-812. doi:10.1016/j.amjsurg.2020.01.048.
Barakzai MD, et al. Pediatric case of trichobezoar leading to gastric perforation. Radiol Case Rep. 2026;21(3):1121-1126. doi:10.1016/j.radcr.2025.11.060.
Karpuz YE, et al. Fatal Gastric Perforation Caused by Undiagnosed Trichobezoar in an Adolescent: A Case Report. Clin Pract Cases Emerg Med. 2026;10(2):195-199. doi:10.5811/cpcem.52931.
Jacques R, et al. Fatal Rapunzel Syndrome: Gastric and Intestinal Trichobezoars in a Child With Trichotillomania. Am J Forensic Med Pathol. 2023;44(3):210-215. doi:10.1097/PAF.0000000000000849.
Morris M, et al. Recurrent Rapunzel Syndrome in an Adolescent Female. Am Surg. 2023;89(8):3665-3667. doi:10.1177/00031348231173942.
Chen L, et al. Rapunzel syndrome in children: a retrospective review of ten cases combined with literature review in a tertiary referral center. Pediatr Surg Int. 2024;40(1):121. doi:10.1007/s00383-024-05705-0.
Paek SH, et al. Acute Abdominal Pain with Obstructing Trichobezoar: A Pediatric Case of Rapunzel Syndrome Diagnosed in a Pediatric Emergency Department. Pediatr Rep. 2025;17(3):53. doi:10.3390/pediatric17030053.
Shipman KE, et al. Minimally invasive surgery for intragastric trichobezoar in pediatrics: A case report. Int J Surg Case Rep. 2025;133:111649. doi:10.1016/j.ijscr.2025.111649.
Saleh IEA, et al. Case series of pediatric gastric trichobezoars: diagnostic challenges, management outcomes, and the imperative for psychiatric follow-up. Int J Surg Case Rep. 2026;138(3):325-331. doi:10.1097/RC9.0000000000000216.
Ibrahim H, et al. Transumbilical single-incision laparoscopic-assisted removal of gastric trichobezoars in children: a technical refinement and feasibility study. BMC Surg. 2026;26(1). doi:10.1186/s12893-026-03628-2.
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