Rapunzel Syndrome


Step 1: View clinicals

A 15 year old girl presents with intermittent nausea and vomiting for 1 month; this tended to occur approximately 20 to 30 minutes following meals. Further questioning reveals the presence of continuous dull epigastric pain for 6 months. Her medical and surgical histories are unremarkable. Her full blood count is significant for a Hb of 9.8 g/dL, with MCV 73 fL, MCH 23 pg, MCHC 31 g/dL. A blood film reveals a hypochromic microcytic anemia, with anisopoikilocytosis.

Step 2: Order all relevant investigations

Ultrasound Abdomen

Ultrasonography shows a vague mass in the stomach, with an acoustic shadow suggestive of a calcified margin.

Upper GI Endoscopy

There is a blackened, voluminous mass composed of strands of hair and food residue in the antrum and low body of the stomach, extending towards the pylorus and blocking passage of the endoscope.

CT Abdomen

There is a large, hypodense intragastric mass, which extends through the pylorus, upto the proximal jejunum. No other abnormalities are noted.

Iron Studies

Serum ferritin: 11 µg/l (15-250) Serum iron: 6 µg/l (8-30) Total iron-binding capacity: 800 μg/dL (255-450)

Step 3: Select appropriate management

Gastric Lavage Therapy
Psychiatric Referral
Oral Iron Supplements
Laparoscopic Removal

Score: ★★☆