A Hairy Tail of Rapunzel Syndrome: A Video Case Report of the Laparoscopic Management of a Giant Trichobezoar Causing Gastric Outlet Obstruction

Trichobezoars are rare gastrointestinal concretions formed by accumulated ingested hair, occurring predominantly in young women with trichotillomania and trichophagia.Extension beyond the pylorus into the small bowel defines Rapunzel syndrome, which may present with gastric outlet obstruction.We report a 25-year-old woman with a three-year history of progressive weight loss, early satiety, postprandial vomiting, and iron-deficiency anaemia.Oesophago-gastro-duodenoscopy and computed tomography revealed a giant gastric trichobezoar extending to the distal duodenum.After two unsuccessful endoscopic extraction attempts, laparoscopic gastrotomy with en bloc extraction of a 38-cm, 220-g trichobezoar (weighed without the retrieval bag or container) with a 14-cm duodenal tail was performed.Recovery was uneventful; postoperative contrast study showed no leak or obstruction.At three months, the patient was asymptomatic, gaining weight, and engaged in cognitive behavioural therapy.Laparoscopic gastrotomy is feasible for giant trichobezoars when adequate exposure and contained extraction can be achieved.Concurrent psychiatric assessment and ongoing psychological care are essential to prevent recurrence.