CureusRapunzel Syndrome in a Child with Sensory Feeding Difficulties and Attention-Deficit Hyperactivity Disorder

A 10-year-old girl with ADHD and sensory feeding difficulties presented with 8 months of progressive weight loss, dropping from the 60th to 1st weight centile, before MR enterography revealed a 15–16 cm trichobezoar extending into the duodenum. Laparotomy confirmed Rapunzel syndrome; weight recovered to the 24th centile at three months.

🔬 Clinical Considerations

• Neurodevelopmental profiles can mask surgical pathology: sensory feeding disorders and ADHD may delay recognition of trichobezoar, mimicking functional GI conditions
• Rapunzel syndrome can present without visible hair loss or overt trichotillomania, removing a key diagnostic cue pediatricians typically rely on
• MR enterography identified the mass without radiation exposure after ultrasound failed, supporting its role when initial imaging is inconclusive in children
• Iron deficiency anemia with unexplained weight loss in a child with complex feeding behaviors warrants imaging beyond standard workup

🎯 Practice Applications

• Include trichobezoar in the differential for unexplained pediatric weight loss with abdominal pain
• Consider MR enterography when ultrasound is non-diagnostic and CT radiation is a concern
• Refer to behavioral health early when neurodevelopmental factors complicate feeding disorder evaluation
• Coordinate multidisciplinary follow-up: surgery, dietetics, and CAMHS for recurrence prevention

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