Trichobezoars are masses of swallowed hair that collect in the gastrointestinal tract, most often in the stomach. This is known as “Rapunzel syndrome” when it spreads into the small intestine. Traditionally, removal has been accomplished by a laparotomy; however, effective endoscopic removal has also been reported. A 9-year-old girl with undiagnosed celiac disease and Rapunzel syndrome underwent endoscopic excision of a big trichobezoar, which was followed by unexpected numerous perforations of the small bowel and stomach. During endoscopy, argon plasma coagulation (APC) and snare electrocautery were used to remove the trichobezoar piecemeal, and about 70% was eliminated with no apparent evidence of mucosal injury. It was later revealed that around 20 of her dolls were missing their hair. When the manufacturer’s composition of a certain doll hair was investigated, it was revealed that it may be harmful if burnt. It was thus believed that a confluence of elements had conspired to cause perforation, namely the potentially dangerous gas generated by the electrical energy applied to the synthetic hair and probable mucosal injury caused by the physical abrasion of this hair.

A study of the literature on endoscopic attempts to remove trichobezoars, regardless of the outcome, shows a 30.7 percent success rate.