{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T21:58:36Z","timestamp":1781387916928,"version":"3.54.1"},"reference-count":17,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2023,2,9]],"date-time":"2023-02-09T00:00:00Z","timestamp":1675900800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,2,9]],"date-time":"2023-02-09T00:00:00Z","timestamp":1675900800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e0 degli Studi di Roma La Sapienza"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Forensic Sci Med Pathol"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Trichotillomania is a psychiatric disorder characterized by recurring urges to pulling out hairs, eyelashes, or down in other parts of the body. Trichophagia, which is the urge to ingesting the pulled-out hairs, can cause Rapunzel syndrome, an unusual disorder where gastric trichobezoars can be found in the small intestine. Trichobezoars, amorphous masses composed of undigested food formed by hairs, can obstruct the gastrointestinal tract up to simulating symptoms typical of bowel obstruction. Rapunzel syndrome, named after Grimm\u2019s tale, may cause death, especially in the pediatric population, being it seldom over the age of 6; moreover, developing countries and environmental and familiar issues are listed as uncertain risk factors. The present case report deals with the death of a 4-year-old female occurred after lunch and following a series of vomit events; while no traumatic or pathological findings were revealed at the external examination, the autopsy revealed three large trichobezoars localized in the stomach and the small intestine. Despite death was due to gastrointestinal obstruction for multiple trichobezoars and collateral bronchoaspiration of dietary material, histological findings were totally non-specific, meaning that it is sometimes difficult to conclude that death is related to the primary pathological condition.<\/jats:p>","DOI":"10.1007\/s12024-023-00588-4","type":"journal-article","created":{"date-parts":[[2023,2,9]],"date-time":"2023-02-09T17:49:30Z","timestamp":1675964970000},"page":"207-214","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["An atypical death from Rapunzel syndrome: a case report"],"prefix":"10.1007","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8308-1373","authenticated-orcid":false,"given":"Gianluca Nicol\u00f2","family":"Piras","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8297-7701","authenticated-orcid":false,"given":"Luca","family":"Tomassini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edoardo","family":"Bottoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4696-0560","authenticated-orcid":false,"given":"Cira","family":"di Gioia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1030-924X","authenticated-orcid":false,"given":"Costantino","family":"Ciallella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,2,9]]},"reference":[{"issue":"3","key":"588_CR1","doi-asserted-by":"publisher","first-page":"-","DOI":"10.1159\/000102098","volume":"24","author":"S Naik","year":"2007","unstructured":"Naik S, et al. Rapunzel syndrome reviewed and redefined. Dig Surg. 2007;24(3). https:\/\/doi.org\/10.1159\/000102098.","journal-title":"Dig Surg"},{"issue":"4","key":"588_CR2","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1002\/mds.24898","volume":"27","author":"T M\u00fcller","year":"2012","unstructured":"M\u00fcller T, Haas T, L\u00fctge S, Marg M, Ehret R. Trichophagia affects response to duodenal levodopa\/carbidopa gel administration. Mov Disord. 2012;27(4):588\u201390. https:\/\/doi.org\/10.1002\/mds.24898.","journal-title":"Mov Disord"},{"key":"588_CR3","unstructured":"Abusw S, Administration MHS. Table 3.27, DSM-IV to DSM-5 trichotillomania (hair-pulling disorder) comparison. Giugno.\u00a02016. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK519704\/table\/ch3.t27\/ (Consultato 13 Marzo 2022)."},{"issue":"11","key":"588_CR4","doi-asserted-by":"publisher","first-page":"-","DOI":"10.1016\/j.jpedsurg.2020.04.020","volume":"55","author":"MB Mirza","year":"2020","unstructured":"Mirza MB, Talat N, Saleem M. Gastrointestinal trichobezoar: an experience with 17 cases. J Pediatr Surg. 2020;55(11). https:\/\/doi.org\/10.1016\/j.jpedsurg.2020.04.020.","journal-title":"J Pediatr Surg"},{"issue":"2","key":"588_CR5","doi-asserted-by":"publisher","first-page":"-","DOI":"10.4103\/ajps.AJPS_110_20","volume":"19","author":"B Haggui","year":"2022","unstructured":"Haggui B, et al. Management of trichobezoar: about 6 cases. Afr J Paediatr Surg. 2022;19(2). https:\/\/doi.org\/10.4103\/ajps.AJPS_110_20.","journal-title":"Afr J Paediatr Surg"},{"key":"588_CR6","doi-asserted-by":"crossref","unstructured":"Marginean CO, Melit LE, Sasaran MO, Marginean R, Derzsi Z. Rapunzel syndrome\u2014an extremely rare cause of digestive symptoms in children: a case report and a review of the literature. Front Pediatr. 2021;9.\u00a0Consultato: 18 Marzo 2022. [Online]. Disponibile su: https:\/\/www.frontiersin.org\/article\/10.3389\/fped.2021.684379.","DOI":"10.3389\/fped.2021.684379"},{"issue":"2","key":"588_CR7","doi-asserted-by":"publisher","first-page":"50","DOI":"10.12998\/wjcc.v5.i2.50","volume":"5","author":"O Obinwa","year":"2017","unstructured":"Obinwa O, Cooper D, Khan F, O\u2019Riordan JM. Rapunzel syndrome is not just a mere surgical problem: a case report and review of current management. World J Clin Cases. 2017;5(2):50\u20135. https:\/\/doi.org\/10.12998\/wjcc.v5.i2.50.","journal-title":"World J Clin Cases"},{"issue":"5","key":"588_CR8","doi-asserted-by":"publisher","first-page":"-","DOI":"10.1007\/s00268-006-0619-y","volume":"31","author":"TW Ho","year":"2007","unstructured":"Ho TW, Koh DC. 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