Isolated ileal trichobezoar causing small bowel obstruction in a child without psychiatric history: a rare variant of Rapunzel syndrome: case report

Trichobezoars are rare gastrointestinal masses composed of ingested hair, often associated with trichotillomania and trichophagia. When the hair mass extends beyond the stomach into the small intestine, it forms to Rapunzel syndrome, a rare cause of bowel obstruction. his case contributes to the surgical literature by presenting an unusual pediatric presentation of Rapunzel syndrome complicated by small‑bowel obstruction, emphasizing the diagnostic value of timely imaging and highlighting the importance of involving psychiatric assessment. A 6-year old girl presented with a 3-day history of colicky abdominal pain, constipation, and abdominal distention. She had no prior medical or psychiatric history. Initial imaging demonstrated bowel dilatation, and contrast-enhanced Computed Tomography (CT) confirmed distal small bowel obstruction. Exploratory laparotomy revealed a 20-cm trichobezoar located approximately 40 cm proximal to the terminal ileum. The mass was removed through a 10-cm enterotomy, and bowel continuity was restored using the Henoch–Mikulicz technique. Postoperative recovery was uneventful. The patient was referred for psychiatric evaluation. This case highlights an unusual presentation of Rapunzel syndrome in a young child without a known psychiatric history. Early imaging and timely surgical intervention are critical for diagnosis and treatment. Long-term psychiatric follow-up is essential to prevent recurrence.