Rapunzel syndrome: Trichobezoar-induced pancreatitis unraveled.

Trichobezoars are rare hair-based intraluminal foreign bodies that may cause significant gastrointestinal complications, particularly when extending into the duodenum as in Rapunzel syndrome. We report the case of an 11-year-old girl with sensory processing difficulties and undiagnosed avoidant/restrictive food intake disorder (ARFID), who presented with 1 month of worsening abdominal pain, emesis, and elevated lipase (>1200 U/L). Imaging revealed a large gastric bezoar with duodenal extension and acute necrotizing pancreatitis. Surgical removal with anterior gastrotomy confirmed presence of a trichobezoar composed of hair and food material. Postoperative management included broad-spectrum antibiotics, pain control, and psychological support. The patient recovered well and was discharged with follow-up for autism spectrum disorder and ARFID. This case highlights a rare but serious complication of trichobezoars and underscores the importance of multidisciplinary care in patients with behavioral feeding disorders and gastrointestinal complications.