13-Year-Old with Cryptic Abdominal Pain

A 13-year old female patient presented to the emergency department (ED) with four days of intermittent non-radiating, left upper quadrant pain, associated with non-bloody, nonbilious emesis and decreased appetite. The patient had been evaluated by a gastroenterologist three months prior for abdominal pain. At that time an esophagogastroduodenoscopy revealed a trichobezoar in the stomach too large for endoscopic removal. Elective surgical removal had been offered to the patient, although surgery had not yet been scheduled. Vital signs were within reference limits for the patient’s age. The patient had tenderness throughout the left upper quadrant, however there was no guarding or rebound tenderness. The patient underwent computed tomography (CT) of the abdomen and pelvis, which confirmed the thichobezoar in the stomach and intussusception of the bowel (Figures 1 and 2) consistent with Rapunzel Syndrome.