{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T15:56:09Z","timestamp":1791302169802,"version":"4.1.0"},"reference-count":13,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"C","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2024,12,7]],"date-time":"2024-12-07T00:00:00Z","timestamp":1733529600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction and importance:<\/jats:title>\n                    <jats:p>Trichobezor is a mass of accumulated ingested hair in the gastric lumen. Rapunzel syndrome is an extension of these bezoars beyond the pylorus. The formation of trichobezoar is invariably linked to trichotillomania and trichophagia. Convergence of trichotillomania and trichophagia resulting in the formation of massive trichobezoar and causing acute intestinal obstruction is a rare clinical manifestation. This case report aims to shed light on diagnostic intricacies and prompt management of such exceptional cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation:<\/jats:title>\n                    <jats:p>This case report features a 13-year-old girl who presented to the surgical emergency department with complaints of abdominal pain, nausea, vomiting, and epigastric fullness for 5-6 months. She also described tufts of hair in vomitus and stools for the past few weeks. Due to these symptoms, she started experiencing significant weight loss, pallor, and pedal edema. Her Investigations revealed a large trichobezoar causing gastrointestinal obstruction and she was managed with exploratory laparotomy and gastrotomy followed by multidisciplinary care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical discussion:<\/jats:title>\n                    <jats:p>Trichobezoar develops secondary to trichotillomania and trichophagia. These disorders are deeply rooted in psychosocial stressors. This unique presentation highlights the need for awareness regarding such rare causes of intestinal obstruction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Psychosocial stressors, trichotillomania, and trichophagia often go unnoticed in teenagers resulting in drastic consequences. A multidisciplinary approach is required to diagnose and manage gastrointestinal obstruction secondary to Rapunzel Syndrome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1016\/j.ijscr.2024.110720","type":"journal-article","created":{"date-parts":[[2024,12,9]],"date-time":"2024-12-09T03:09:15Z","timestamp":1733713755000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Rapunzel syndrome leading to acute intestinal obstruction in a teenager: A rare case report"],"prefix":"10.1097","volume":"126","author":[{"given":"Ahmad","family":"Ismail","sequence":"first","affiliation":[{"name":"King Edward Medical University, Lahore 54000, Punjab, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Shair","family":"Ismail","sequence":"additional","affiliation":[{"name":"Faisalabad Medical University Faisalabad, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Urooj","family":"Fatima","sequence":"additional","affiliation":[{"name":"Faisalabad Medical University Faisalabad, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Bakhtiar","sequence":"additional","affiliation":[{"name":"King Edward Medical University, Lahore 54000, Punjab, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed Mujtaba","family":"Haider","sequence":"additional","affiliation":[{"name":"King Edward Medical University, Lahore 54000, Punjab, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"3","key":"R1-78-20260508","doi-asserted-by":"crossref","first-page":"193","DOI":"10.47892\/rgp.2022.423.1343","article-title":"Haito Ch\u00e1vez Y. Tricobezoar g\u00e1strico: reporte de un caso y revisi\u00f3n de la literatura [Gastric trichobezoar: case report and literature review]","volume":"42","author":"Huaco Aranguri","year":"2022","journal-title":"Rev. Gastroenterol. Peru"},{"issue":"4","key":"R2-78-20260508","doi-asserted-by":"crossref","first-page":"336","DOI":"10.4253\/wjge.v7.i4.336","article-title":"Review of the diagnosis and management of gastrointestinal bezoars","volume":"7","author":"Iwamuro","year":"2015","journal-title":"World J. Gastrointest. Endosc."},{"issue":"5","key":"R3-78-20260508","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1007\/s00383-010-2570-0","article-title":"Management of trichobezoar: case report and literature review","volume":"26","author":"Gorter","year":"2010","journal-title":"Pediatr. Surg. 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(Heidelb)."},{"issue":"9","key":"R8-78-20260508","first-page":"32","article-title":"Trichobezoar requiring surgical intervention","volume":"31","author":"Maini","year":"2018","journal-title":"J. Am. Acad. Phys. Assist."},{"key":"R9-78-20260508","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1176\/appi.ajp.162.2.242","article-title":"Hair apparent: Rapunzel syndrome","volume":"162","author":"Frey","year":"2005","journal-title":"Am. J. Psychiatry"},{"key":"R10-78-20260508","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1097\/00006842-199809000-00025","article-title":"Trichobezoars in trichotillomania: case report and literature overview","volume":"60","author":"Bouwer","year":"1998","journal-title":"Psychosom. Med."},{"key":"R11-78-20260508","first-page":"467","article-title":"An unusual case of the trichobezoar: the Rapunzel syndrome","volume":"77","author":"Deslypere","year":"1982","journal-title":"Am. J. Gastroenterol."},{"key":"R12-78-20260508","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1111\/j.1468-3083.2006.01590.x","article-title":"Trichotillomania \u00b1 trichobezoar: revisited","volume":"20","author":"Sehgal","year":"2006","journal-title":"Eur. Acad. Dermatol. Venereol."},{"key":"R13-78-20260508","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/j.psc.2014.05.005","article-title":"Diagnosis, evaluation, and management of trichotillomania","volume":"37","author":"Woods","year":"2014","journal-title":"Psychiatr. Clin. North Am."},{"issue":"5","key":"R14-78-20260508","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1097\/JS9.0000000000000373","article-title":"The SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines","volume":"109","author":"Sohrabi","year":"2023","journal-title":"Int. J. Surg. Lond. 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