Rapunzel Syndrome Presenting as Acute Pancreatitis With Biliary Ductal Dilatation in a Child: A Rare Mechanical Etiology of Pediatric Pancreatitis.

Rapunzel syndrome is a rare manifestation of trichobezoar in which a gastric hair mass extends beyond the pylorus into the small intestine. It typically presents with abdominal pain, nausea, vomiting, early satiety, weight loss, or bowel obstruction. Presentation of acute pancreatitis is uncommon and may delay diagnosis. We report a previously healthy nine-year-old girl who presented with progressive epigastric pain, nausea, vomiting, decreased oral intake, and constipation. Laboratory evaluation demonstrated markedly elevated lipase levels consistent with acute pancreatitis. Abdominal ultrasound revealed intrahepatic and extrahepatic biliary ductal dilatation without gallstones or choledocholithiasis. Symptoms initially improved with supportive care; however, persistent pain and a palpable epigastric mass prompted further imaging. Computed tomography demonstrated a large gastric trichobezoar extending into the jejunum, consistent with Rapunzel syndrome, with associated intussusception and compression of the pancreatic duct. The patient underwent exploratory laparotomy with complete bezoar removal, followed by resolution of symptoms and normalization of lipase levels. This case highlights Rapunzel syndrome as a rare mechanical cause of pediatric pancreatitis and emphasizes the importance of considering extrinsic compression when pancreatitis occurs with biliary dilatation and normal liver biochemical findings.