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A Rapunzel with a difference
  1. N Ramadan,
  2. N A Pandya,
  3. B Bhaduri
  1. Maidstone Hospital, Maidstone ME16 9QQ, UK; ankur.pandya{at}virgin.net

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An 8 year old girl with a severe language disorder and a background of fetal valproate syndrome presented with a three month history of abdominal pain, significant weight loss, and anorexia. Routine bloods and an abdominal ultrasound were normal. Upper gastrointestinal endoscopy revealed a mass of hair obstructing the pylorus with its extension into the duodenum (fig 1) necessitating surgical removal. A barium meal revealed a filling defect in the stomach (fig 2).

Trichobezoars are composed of huge amounts of entwined hair and undigested food. This forms an obstructive foreign body. They can extend into the small intestine, with a tail (Rapunzel syndrome).1–3

Trichotillomania (pulling at one's own hair) and trichophagia are closely related and can lead to a trichobezoar. They predominantly affect females in early childhood or adolescence.4,5 Our patient had developed a bald patch due to obsessive hair pulling. Trichobezoars cause abdominal symptoms, suchas postprandial fullness, intermittent vomiting, and abdominal pain. Surgery is indicated to relieve obstruction and pressure necrosis.6 A multidisciplinary approach should be adopted to prevent recurrence. In patients with learning difficulties and gastrointestinal symptoms a low threshold for upper gastrointestinal endoscopy should be maintained.

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