Upper gastrointestinal bleeding, an unusual presentation of Rapunzel syndrome

Abstract

Gastrointestinal bezoars in the pediatric age group have an unusual presentation, and their clinical manifestation is mainly associated with obstructive conditions of the gastrointestinal tract, and are generally made up of hair and food debris. In a smaller number, it has been seen that from its usual location, which is the stomach, bezoar structures could extend into the duodenum, jejunum, ileum, and even colon, giving the appearance of a "Rapunzel tail". 
    We present the case of a 7-year-old girl with an atypical initial presentation of Rapunzel syndrome, secondary to a trichobezoar. The patient did not have previous psychiatric history, nor reports of any disturbance at school. She was admitted to the emergency room due to upper gastrointestinal bleeding and required a subsequent transfusion of blood products. During her hospitalization, an upper digestive endoscopy was performed, with the diagnosis of Rapunzel syndrome, in addition to the presence of two Forrest II-C, III gastric ulcers and severe erythematous gastritis in the region of the antrum and body. Medical treatment was started without success, for which the bezoar had to be surgically removed.
    Therefore, we want to point out the importance of deepening certain aspects such as the medical history and background in this type of patient, since it is a disorder linked to behavioral and mood alterations; likewise, remember the less frequent clinical symptoms such as upper gastrointestinal bleeding, but which in turn can be lethal if we don't act promptly. In the same way, the comprehensive approach with the support of the family and the intervention of psychology and/or psychiatry is vital to prevent recurrences.