Rapunzel Syndrome in a Child With Sensory Feeding Difficulties and Attention-Deficit Hyperactivity Disorder

Rapunzel syndrome is a rare form of trichobezoar characterized by the extension of a gastric hair mass beyond the pylorus into the small intestine. It is most commonly reported in adolescents with underlying psychiatric illness. We describe a diagnostically challenging case in a younger child with neurodevelopmental vulnerability and sensory feeding difficulties. A 10-year-old girl with attention-deficit hyperactivity disorder, sensory aversion to food textures, and heterozygous chromosomal deletions presented with progressive weight loss, anxiety around eating, and intermittent abdominal pain. Initial investigations for faltering growth and anemia were inconclusive. Magnetic resonance enterography, performed to exclude inflammatory bowel disease, demonstrated a large intragastric filling defect extending into the duodenum. Surgical exploration confirmed a large trichobezoar consistent with Rapunzel syndrome, which was successfully removed via laparotomy. This case highlights how Rapunzel syndrome may masquerade as a functional or sensory feeding disorder and emphasizes the value of magnetic resonance enterography as a radiation-free diagnostic modality in pediatric patients with unexplained weight loss.