Surgical Management and Outcomes of Pediatric Gastrointestinal Bezoars Including Rapunzel Syndrome: A 9-year Single-center Case Series

BACKGROUND: Gastrointestinal bezoars are uncommon intraluminal masses frequently associated with psychiatric disorders in children. This study aimed to analyze the clinical characteristics, management strategies, and outcomes of pediatric bezoar cases at a tertiary care centre. MATERIALS AND METHODS: A retrospective analysis was conducted of all children aged ≤18 years who underwent surgical treatment for bezoars between January 2016 and December 2024. Data collected included demographics, clinical presentation, psychiatric history, laboratory parameters, imaging findings, operative details, complications, and follow-up outcomes. RESULTS: Nine patients (seven females and two males) with a mean age of 8.2 years (range: 4-11 years) were included. All patients presented with abdominal pain, vomiting, and distension. Weight loss was present in seven patients (77.8%), palpable abdominal mass in seven (77.8%), and rectal bleeding in one (11.1%). Trichotillomania was identified in eight patients (88.9%) and pica in one (11.1%). Laboratory findings revealed universal anemia (mean hemoglobin: 9.04 g/dL) and hypoalbuminemia (mean albumin: 1.9 g/dL). Computed tomography (CT) confirmed bezoars in all examined cases. Five cases were Rapunzel syndrome, three were gastric trichobezoars, and one was an ileal phytobezoar, with sizes ranging from 18 to 97 cm. Eight patients underwent laparotomy with gastrotomy, and one underwent manual antegrade milking. Postoperative complications occurred in four patients (44.4%), predominantly surgical site infections. No mortality or recurrence was observed during 6 months to 2 years of follow-up. CONCLUSIONS: Pediatric bezoars in this series were associated with psychiatric comorbidities and nutritional compromise. CT was reliable for diagnosis, and most cases required surgical management. No recurrence was observed during follow-up.