Background: Trichobezoar is an uncommon clinical entity in which ingested hair mass accumulates within the digestive tract. Trichobezoars are usually located in the stomach, but may extend through the pylorus into the duodenum and small bowel (Rapunzel syndrome). This entity is usually associated with trichotillomania and trichophagia or other psychiatric disorders. It is generally observed in children and young females with psychological disorders. Untreated cases may lead to grave complications. We present our experience with five patients and provide a review of the recent literature.

Material and Methods: We retrospectively analysed the clinical data of five patients treated for trichobezoar in pediatric surgery department during 4-year-period between 2018 and 2022. Their medical charts were reviewed with respect to symptoms, diagnostic procedures including any Imaging (abdominal ultrasonography and abdominal computed tomography) or upper GI endoscopy and treatment. 

Results: Our study involved 5 girls aged 7 to 12 years. All cases presented with symptoms of epigastric pain associated with vomiting of recently ingested food and weight loss in three cases. Physical examination revealed a hard epigastric mass in all cases. The trichobezoar was confined to the stomach in 4 cases. An extension into the jejunum was observed in 1 case. All patients were surgically treated. In one case, the attempt of endoscopic extraction failed and patient was later operated. On surgical exploration gastrotomy was done in all the patients to extract the hair bezoar even those with jejunal extension. All patients proved to suffer from trichophagia and referred to a child psychiatrist or psychologist for regular follow-up. No recurrences have been reported.

Conclusion: According to our experience and in line with the published results, conventional laparotomy is still the treatment of choice. The literature provides no evidence of superiority of endoscopy or laparoscopy. After successful treatment, psychiatric consultation is imperative to prevent recurrence and improve long term prognosis.

Keywords: Rapunzel syndrome, Trichobezoar, Trichotillomania, Gastrotomy, Endoscopy.

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Dr Simmi K Ratan

Dir. Professor & Head, Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi-110002, India