Rapunzel Syndrome as a Complication of Childhood-Onset Trichotillomania.

Introduction: Rapunzel syndrome is a rare and potentially life-threatening complication of trichotillomania with trichophagia, characterized by the extension of a gastric trichobezoar into the small intestine. Diagnosis is frequently delayed due to nonspecific presenting symptoms, and management requires both surgical intervention and psychiatric treatment to prevent recurrence. Patient Case: We report the case of a 22-year-old woman with childhood-onset trichotillomania and trichophagia who presented with nonspecific abdominal complaints. Imaging revealed a large intragastric mass, and endoscopy confirmed a dense trichobezoar extending through the pylorus into the duodenum, consistent with Rapunzel syndrome. Endoscopic removal was unsuccessful, and the patient underwent open gastrotomy with intact removal of the mass without complication. Psychiatric evaluation revealed a long history of hairpulling and ingestion behaviors beginning in early childhood, with limited prior psychiatric treatment. Discussion: This case illustrates the cumulative medical risk of untreated chronic, childhood-onset trichotillomania with trichophagia, particularly when hair-ingestion behaviors persist without sustained trichotillomania-specific behavioral treatment. Its contribution to the literature lies in the detailed longitudinal psychiatric characterization of symptom progression and the consideration of comorbid attention-deficit/hyperactivity disorder (ADHD), which may be relevant to the hairpulling and ingestion behaviors themselves through attentional dysregulation, impulsivity, impaired inhibitory control, and automaticity. Conclusion: Rapunzel syndrome represents a severe consequence of chronic hairpulling and ingestion behaviors. Early identification of trichophagia, psychiatric referral, and sustained behavioral treatment are essential to prevent progression to life-threatening complications and to reduce recurrence following surgical intervention.