A 16-Year-Old Girl with Abdominal Pain

This case report details the diagnostic journey of a 16-year-old girl with progressive, intermittent epigastric pain, nausea, and vomiting over four weeks. Initial evaluations including laboratory tests and imaging revealed leukocytosis, iron-deficiency anemia, and nonspecific abdominal tenderness. Despite multiple emergency visits, common etiologies such as constipation, gastritis, and functional GI disorders were excluded. A pivotal clue pain relief following emesis prompted further imaging and ultimately an esophagogastroduodenoscopy, which revealed a large trichobezoar extending into the duodenum (Rapunzel syndrome). Surgical removal via gastrostomy was successful. The discussion highlights challenges in diagnosing mechanical gastric-outlet obstruction in adolescents and explores underlying psychiatric comorbidities like trichotillomania and trichophagia. The article emphasizes a multidisciplinary approach to recurrence prevention through behavioral therapy and psychiatric follow-up.

This case report details the diagnostic journey of a 16-year-old girl with progressive, intermittent epigastric pain, nausea, and vomiting over four weeks. Initial evaluations including laboratory tests and imaging revealed leukocytosis, iron-deficiency anemia, and nonspecific abdominal tenderness. Despite multiple emergency visits, common etiologies such as constipation, gastritis, and functional GI disorders were excluded. A pivotal clue pain relief following emesis prompted further imaging and ultimately an esophagogastroduodenoscopy, which revealed a large trichobezoar extending into the duodenum (Rapunzel syndrome). Surgical removal via gastrostomy was successful. The discussion highlights challenges in diagnosing mechanical gastric-outlet obstruction in adolescents and explores underlying psychiatric comorbidities like trichotillomania and trichophagia. The article emphasizes a multidisciplinary approach to recurrence prevention through behavioral therapy and psychiatric follow-up.