{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T14:57:48Z","timestamp":1774277868095,"version":"3.50.1"},"reference-count":18,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,22]],"date-time":"2026-03-22T00:00:00Z","timestamp":1774137600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>We report the case of a school-aged patient with attention-deficit\/hyperactivity disorder who presented with a palpable epigastric mass. The initial abdominal ultrasonography indicated the presence of a heterogeneous space-occupying lesion in the upper abdomen. Subsequent computed tomography revealed a large intragastric mass with a mottled air-containing density, an imaging feature characteristic of a bezoar. Esophagogastroduodenoscopy confirmed a massive trichobezoar extending beyond the pylorus into the duodenum, consistent with Rapunzel syndrome. Although the endoscopic removal proved unsuccessful, a subsequent surgical extraction via laparotomy yielded a 22 cm trichobezoar. Further history revealed prior hair-picking behavior approximately one year earlier, with a localized bald patch noted by her parents. This case highlights the characteristic multimodal imaging findings of trichobezoars and serves to emphasize the diagnostic challenge posed by a limited clinical history in children with psychiatric comorbidities presenting with abdominal masses.<\/jats:p>","DOI":"10.3390\/diagnostics16060940","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T13:53:34Z","timestamp":1774274014000},"page":"940","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Diagnostic Challenge of Rapunzel Syndrome: Multimodal Imaging Findings in a Child"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0901-0654","authenticated-orcid":false,"given":"Chih-Hao","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Pediatrics, MacKay Children\u2019s Hospital, Taipei 104217, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9242-4502","authenticated-orcid":false,"given":"Shu-Chao","family":"Weng","sequence":"additional","affiliation":[{"name":"Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children\u2019s Hospital, Taipei 104217, Taiwan"},{"name":"Department of Medicine, Mackay Medical University, New Taipei City 252005, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e125","DOI":"10.1016\/j.cgh.2020.06.015","article-title":"A Giant Trichobezoar Diagnosed by Ultrasound, Confirmed by Upper Endoscopy, and Managed by Minimally Invasive Laparoscopic Surgery","volume":"19","author":"Lisi","year":"2021","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S1301","DOI":"10.14309\/00000434-201710001-02389","article-title":"A Rare but Significant Clinical Entity: Trichobezoar: 2388","volume":"112","author":"Malik","year":"2017","journal-title":"Off. J. Am. Coll. Gastroenterol. ACG"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"65","DOI":"10.2214\/ajr.177.1.1770065","article-title":"Gastrointestinal bezoars: Sonographic and CT characteristics","volume":"177","author":"Gil","year":"2001","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Sacco, M.A., Gualtieri, S., Princi, A., Tarda, L., Tarallo, A.P., Calanna, L., Lombardo, S., Calafiore, J., Gratteri, S., and Aquila, I. (2024). Rapunzel Syndrome: Clinical, Diagnostic and Forensic Aspects in Related Deaths\u2014A Review of the Literature. J. Clin. 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Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e103887","DOI":"10.1136\/bmjopen-2025-103887","article-title":"From obstruction to ischaemia: A systematic review and meta-analysis on the diagnostic accuracy of CT scans in identifying small and large bowel obstruction, underlying causes and predicting critical complications in adults","volume":"15","author":"Ahmad","year":"2025","journal-title":"BMJ Open"},{"key":"ref_8","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. Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e283","DOI":"10.1002\/deo2.283","article-title":"Trichobezoar effectively treated with direct endoscopic injection of Coca-Cola: A case report","volume":"4","author":"Matsuoka","year":"2024","journal-title":"DEN Open"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e5969","DOI":"10.1097\/MD.0000000000005969","article-title":"Endoscopic retrieval of gastric trichophytobezoar: Case report of a 12-year-old girl with trichophagia","volume":"96","author":"Zhao","year":"2017","journal-title":"Medicine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e11320","DOI":"10.1097\/MD.0000000000011320","article-title":"Etiological aspects of intragastric bezoars and its associations to the gastric function implications: A case report and a literature review","volume":"97","author":"Khan","year":"2018","journal-title":"Medicine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1067\/mge.2000.108927","article-title":"Small bowel obstruction due to trichobezoar: Role of upper endoscopy in diagnosis","volume":"52","author":"Alsafwah","year":"2000","journal-title":"Gastrointest. Endosc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1111\/apt.12141","article-title":"Systematic review: Coca-Cola can effectively dissolve gastric phytobezoars as a first-line treatment","volume":"37","author":"Ladas","year":"2013","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.addr.2020.08.008","article-title":"Recent trends in protein and peptide-based biomaterials for advanced drug delivery","volume":"156","author":"Varanko","year":"2020","journal-title":"Adv. Drug Deliv. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2504","DOI":"10.1016\/j.jpedsurg.2020.04.020","article-title":"Gastrointestinal trichobezoar: An experience with 17 cases","volume":"55","author":"Mirza","year":"2020","journal-title":"J. Pediatr. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.rcl.2021.08.008","article-title":"Pediatric Abdominal Masses: Imaging Guidelines and Recommendations","volume":"60","author":"Kim","year":"2022","journal-title":"Radiol. Clin. N. Am."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"W1","DOI":"10.2214\/AJR.11.6642","article-title":"Focal Cystic Abdominal Masses in Pediatric Patients","volume":"199","author":"Ranganath","year":"2012","journal-title":"Am. J. Roentgenol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1097\/PEC.0000000000003238","article-title":"Hair Today, OR Tomorrow: A Multicenter Case Series of Gastric Bezoars in Children Diagnosed With Point-of-Care Ultrasound","volume":"41","author":"Shah","year":"2025","journal-title":"Pediatr. Emerg. 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