Delayed Recognition of Gastric Perforation in a Case of Rapunzel Syndrome

A 15 year old girl with a previous history of psychiatric symptoms and trichophagia (denied any trichotillomania), presented to the surgical emergency department with severe epigastric pain. She was initially managed with masterly inactivity as no indication for exploration was found. Later on investigations revealed gastric mass and ill-defined gastric perforation. Exploratory laparotomy revealed a perforation in anterior wall of stomach which was extended and a huge trichobezoar was found extending upto jejunum. Bezoar was removed and perforation repaired in two layers and covered by omentum. Postoperative recovery was uneventful. She was discharged on 10th postoperative day and referred to psychiatry department for further management.