Rapunzel Syndrome Requiring Open Surgical Excision in an Adolescent Female With Autism Spectrum Disorder: A Case Report

Trichobezoar is a rare but clinically significant cause of gastrointestinal obstruction, typically affecting adolescent females with underlying psychiatric or neurodevelopmental conditions. We report an unusual case of synchronous gastric and duodenal trichobezoar in a 17-year-old female with autism spectrum disorder (ASD) whose guardian denied trichotillomania or pica, highlighting the diagnostic and surgical challenges this presentation poses. The patient presented with a three-week history of diffuse abdominal pain, nausea, and bilious non-bloody emesis. Abdominopelvic CT with contrast demonstrated a continuous large mass in the stomach and duodenum, interpreted as bezoars. Pain was rated 6/10 at presentation, predominantly in the upper quadrants. Diagnostic endoscopy confirmed a trichobezoar at the proximal stomach blocking passage into the pylorus. The patient underwent open exploratory laparotomy with gastrotomy for excision of the gastric trichobezoar and proximal jejunum enterotomy for excision of a second trichobezoar drained from the distal duodenum. The bowel and stomach were closed with running PDS sutures and Lembert reinforcement. Estimated blood loss was 5 cc. The patient was extubated and transferred to the pediatric acute care unit (PACU) in stable condition. This report underscores the importance of considering trichobezoar in adolescent females with neurodevelopmental disorders presenting with upper gastrointestinal symptoms, even in the absence of a reported history of hair ingestion. Multidisciplinary surgical and psychiatric follow-up is essential to prevent recurrence.