{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T03:48:58Z","timestamp":1789616938795,"version":"build-2803163510"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"vor","delay-in-days":25,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Trichobezoars are rare intragastric masses composed of ingested hair, most commonly affecting young females with underlying psychiatric conditions. Rapunzel syndrome is a rare variant characterized by extension beyond the stomach into the small intestine. We report the case of a 27-year-old female with a 6-month history of abdominal pain, vomiting, weight loss, and intolerance to oral intake. Endoscopy revealed a large gastric trichobezoar occupying ~90% of the gastric lumen, causing functional pyloric obstruction. Contrast-enhanced computed tomography demonstrated marked gastric and proximal duodenal dilation with imaging features suggestive of secondary superior mesenteric artery (SMA) syndrome (Welsch T, B\u00fcchler MW, Kienle P. Recalling superior mesenteric artery syndrome. Dig Surg 2007;24:149\u201356. https:\/\/doi.org\/10.1159\/000102097; Ganss A, Rampado S, Savarino E et\u00a0al. Superior mesenteric artery syndrome: a prospective study in a single institution. J Gastrointest Surg 2019;23:997\u20131005. https:\/\/doi.org\/10.1007\/s11605-018-3984-6). Surgical exploration confirmed a giant trichobezoar extending from the pylorus to near the cardia with duodenal extension. Complete removal was achieved via laparotomy and anterior gastrotomy. The postoperative course was uneventful, and psychiatric evaluation confirmed trichotillomania and trichophagia. This case highlights the importance of multimodal diagnosis and suggests a possible pathophysiological relationship between severe gastric obstruction and secondary SMA syndrome.<\/jats:p>","DOI":"10.1093\/jscr\/rjag472","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T11:47:26Z","timestamp":1779968846000},"source":"Crossref","is-referenced-by-count":1,"title":["Giant gastric trichobezoar (Rapunzel syndrome) presenting as gastric outlet obstruction with imaging features suggestive of secondary superior mesenteric artery syndrome in a 27-year-old female: surgical management and multidisciplinary approach"],"prefix":"10.1093","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4341-919X","authenticated-orcid":false,"given":"Pedro Agustin","family":"Lovato Guti\u00e9rrez","sequence":"first","affiliation":[{"name":"Department of General Surgery, Hospital de los Valles, Av. Interoce\u00e1nica Km 12 1\/2 y Av. Florencia , Quito 170902, Pichincha,","place":["Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Molina","sequence":"additional","affiliation":[{"name":"Resident in Emergency Medicine, Hospital Verdi Cevallos Balda , Av. Universitaria y Calle 15 de Abril, Portoviejo, Manab\u00ed,","place":["Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"key":"2026062506222282800_ref1","first-page":"339","article-title":"The Rapunzel syndrome. An unusual complication of intestinal bezoar","volume":"63","author":"Vaughan","year":"1968","journal-title":"Surgery"},{"key":"2026062506222282800_ref2","doi-asserted-by":"publisher","first-page":"99","DOI":"10.3121\/cmr.2009.822","article-title":"Rapunzel syndrome: a comprehensive review of an unusual case of trichobezoar","volume":"7","author":"Gonuguntla","year":"2009","journal-title":"Clin Med Res"},{"key":"2026062506222282800_ref3","doi-asserted-by":"publisher","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"},{"key":"2026062506222282800_ref4","doi-asserted-by":"publisher","first-page":"e05152","DOI":"10.1002\/ccr3.5152","article-title":"A rare giant gastric trichobezoar in a young female patient: case report and review of the literature","volume":"9","author":"Delimpaltadaki","year":"2021","journal-title":"Clin Case Reports"},{"key":"2026062506222282800_ref5","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1159\/000102097","article-title":"Recalling superior mesenteric artery syndrome","volume":"24","author":"Welsch","year":"2007","journal-title":"Dig Surg"},{"key":"2026062506222282800_ref6","doi-asserted-by":"publisher","first-page":"997","DOI":"10.1007\/s11605-018-3984-6","article-title":"Superior mesenteric artery syndrome: a prospective study in a single institution","volume":"23","author":"Ganss","year":"2019","journal-title":"J Gastrointest Surg"},{"key":"2026062506222282800_ref7","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1186\/s40792-023-01631-w","article-title":"The Rapunzel syndrome: a hairy tale","volume":"9","author":"Schuler","year":"2023","journal-title":"Surg Case Rep"},{"key":"2026062506222282800_ref8","doi-asserted-by":"publisher","first-page":"7464","DOI":"10.3390\/jcm13237464","article-title":"Rapunzel syndrome: clinical, diagnostic and forensic aspects in related deaths-a review of the literature","volume":"13","author":"Sacco","year":"2024","journal-title":"J Clin Med"},{"key":"2026062506222282800_ref9","doi-asserted-by":"publisher","first-page":"65","DOI":"10.2214\/ajr.177.1.1770065","article-title":"Gastrointestinal bezoars: sonographic and CT characteristics","volume":"177","author":"Ripoll\u00e9s","year":"2001","journal-title":"AJR Am J Roentgenol"},{"key":"2026062506222282800_ref10","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1007\/s11605-008-0695-4","article-title":"Superior mesenteric artery syndrome: diagnosis and treatment strategies","volume":"13","author":"Merrett","year":"2009","journal-title":"J Gastrointest Surg"},{"key":"2026062506222282800_ref11","doi-asserted-by":"publisher","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 Int"},{"key":"2026062506222282800_ref12","first-page":"42","article-title":"The characterization and treatment of trichotillomania","volume":"57","author":"Christenson","year":"1996","journal-title":"J Clin Psychiatry"},{"key":"2026062506222282800_ref13","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1007\/s44337-024-00132-5","article-title":"Gastric trichobezoar as first presentation of psychiatric disorders in young women: case series","volume":"1","author":"Elnaim","year":"2024","journal-title":"Discov Med"}],"container-title":["Journal of Surgical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2026\/6\/rjag472\/68610160\/rjag472.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2026\/6\/rjag472\/68610160\/rjag472.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T10:23:01Z","timestamp":1782382981000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jscr\/article\/doi\/10.1093\/jscr\/rjag472\/8714316"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,31]]},"references-count":13,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,5,31]]}},"URL":"https:\/\/doi.org\/10.1093\/jscr\/rjag472","relation":{},"ISSN":["2042-8812"],"issn-type":[{"value":"2042-8812","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,6]]},"published":{"date-parts":[[2026,5,31]]},"article-number":"rjag472"}}