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Case Reports
. 2025 Aug 22;17(8):e90733.
doi: 10.7759/cureus.90733. eCollection 2025 Aug.

Rapunzel Syndrome Resulting in Multiple Sites of Simultaneous Intussusception

Eric C Morey  1 , Caitlin Brandle  1 , Stephen Schaffner  1 , Dallas Q Sturdevant  1
Affiliations
Case Reports

Rapunzel Syndrome Resulting in Multiple Sites of Simultaneous Intussusception

Eric C Morey et al. Cureus. .

Abstract

We present a case of Rapunzel syndrome in a nine-year-old girl with nonverbal autism, pica, and trichotillomania, who presented for acute worsening of abdominal pain and vomiting. Imaging revealed a bezoar extending from the stomach through most of the small intestine, resulting in multiple small bowel-small bowel intussusceptions. Open laparotomy confirmed the presence and enabled the removal of gastroenteric trichobezoars. Trichobezoars are seen most often in adolescent females with a history of trichotillomania and trichophagia. Trichobezoars can cause serious complications, including obstruction, perforation, and intussusception, most notable in the setting of Rapunzel syndrome. Abdominal computed tomography is the preferred imaging modality for diagnosis and surgical planning. The current case highlights the unique radiologic features of extensive bezoar disease and emphasizes the importance of early recognition and definitive operative management to reduce morbidity.

Keywords: bezoar; intussusception; rapunzel syndrome; trichobezoar; trichotillomania.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. The supine anterior-posterior abdominal radiograph demonstrates a rounded radiodensity within the stomach, with near-circumferential gastric gas concerning for a bezoar. There is a large amount of stool throughout the colon, with radiopaque contents in the cecum, ascending colon, and transverse colon at the hepatic flexure. The bowel gas pattern is nonspecific, with a paucity of bowel gas and no evidence of free intraperitoneal air
Figure 2
Figure 2. Contrast-enhanced CT images of the abdomen in coronal (2a and 2c) and axial (2b and 2d) views show a large heterogeneous intraluminal mass within the stomach and duodenum, with lamellated, non-enhancing components and intermixed gas, concerning for a trichobezoar
CT: computed tomography
Figure 3
Figure 3. Contrast-enhanced CT images of the abdomen in the axial (3b and 3c) and coronal (3a) planes demonstrate multifocal regions of small bowel telescoping, with a resultant bowel-within-bowel configuration characterized by concentric enhancing bowel walls separated by mesenteric fat. This yields a targetoid appearance in the short-axis plane and a sandwich or pseudokidney sign in the longitudinal axis. Associated bowel wall edema extends from the lower left abdominal quadrant, crosses the mid-abdomen, and terminates in the lower right abdominal quadrant
CT: computed tomography
Figure 4
Figure 4. Contrast-enhanced CT images of the abdomen in axial (4a and 4b) and sagittal (4c) views demonstrate a second small bowel-small bowel intussusception, producing the characteristic CT target sign of concentric layers of enhancing bowel wall separated by mesenteric fat (green arrow). Several foci of concreted stool and undigested material are noted, acting as lead points (red arrows)
CT:  computed tomography
Figure 5
Figure 5. Intraoperative specimen of a gastric trichobezoar
Figure 6
Figure 6. Intraoperative specimen of a small intestine bezoar
See this image and copyright information in PMC

References

    1. Bezoars: from mystical charms to medical and nutritional management. Sanders MK. https://med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2015/1... Practical Gastroenterology. 2004;28:37–51.
    1. A hairy situation: trichobezoar presenting with intussusception, and intestinal and biliary perforation in a child. Baheti AD, Otjen JP, Phillips GS. Radiol Case Rep. 2017;12:42–44. - PMC - PubMed
    1. The surgical management of Rapunzel syndrome: a case series and literature review. Fallon SC, Slater BJ, Larimer EL, Brandt ML, Lopez ME. J Pediatr Surg. 2013;48:830–834. - PubMed
    1. Mezoff EA, Mezoff AG. Pediatric Gastrointestinal and Liver Disease. Vol. 6. Philadelphia: Elsevier; 2021. 29 - Bezoars; pp. 303–306.
    1. The Rapunzel syndrome. An unusual complication of intestinal bezoar. Vaughan ED Jr, Sawyers JL, Scott HW Jr. https://pubmed.ncbi.nlm.nih.gov/5638179/ Surgery. 1968;63:339–343. - PubMed

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