Dawood Tahir, MD, Sai Shilpitha Janga, MD, David Glass, DO, Kyra Herman, DO, Erkanda Ikonomi, MD, Angela Frates, MD Abington Jefferson Hospital, Abington, PA Introduction: When the undigested hair (trichobezoar) encompasses the entire stomach and extends through the small or large intestine, this is termed Rapunzel Syndrome (RS). While trichobezoars are less than 1% in incidence, RS, specifically, is rarer. Wernicke encephalopathy (WE) from RS has no specific incidence or prevalence data available, making it a highly unique presentation. We introduce an exceptional case of a female admitted for diabetic ketoacidosis treatment. Simultaneously, she was diagnosed with WE and dysphagia secondary to RS.
Case Description/
Methods: A 21-year-old female presented with vomiting, altered mental status, fifteen pounds of weight loss, and dysphagia to solids for the last two months, which eventually progressed to liquids in the previous two weeks. At admission, she was hemodynamically stable. The pertinent examination revealed dry oral mucosa; she was alert and oriented to time and place. The labs were consistent with diabetic ketoacidosis, which was managed with aggressive intravenous (IV) fluids and insulin drip. During the hospitalization, she developed weakness in both lower extremities, intermittent confusion, and a new nystagmus. An MRI of the brain with contrast demonstrated enhancement of the bilateral mammillary bodies, a classic finding suggestive of Wernicke's Encephalopathy (WE). Autoimmune and infectious workups resulted negative. The iron panel was consistent with IDA. The MRI of the abdomen showed dilation of the stomach through the proximal jejunum and signs of partial obstruction of the jejunum. Subsequently, the patient underwent an esophagogastroduodenoscopy, which revealed a large trichobezoar extending up to the third portion of the duodenum. Attempted removal with a net or snare was unsuccessful, prompting anterior gastrostomy with successful removal of the trichobezoar. Following this, a psychiatrist evaluated her and attributed her symptoms to undiagnosed chronic anxiety. Her symptoms improved, and she was discharged on oral iron, thiamine supplements, and fluoxetine. Discussion: The RS complications include gastric obstruction and nutritional deficiencies. WE's association with RS has not been reported to date. Therefore, we aim to educate healthcare professionals about rare presentations and various nutritional complications of RS. Moreover, this case highlights how real-time collaboration, an integrated cross-specialty approach, can rapidly adapt to evolving complications of RS, and timely interventions can improve outcomes and survival.
Disclosures: Dawood Tahir indicated no relevant financial relationships. Sai Shilpitha Janga indicated no relevant financial relationships. David Glass indicated no relevant financial relationships. Kyra Herman indicated no relevant financial relationships. Erkanda Ikonomi indicated no relevant financial relationships. Angela Frates indicated no relevant financial relationships.
Dawood Tahir, MD, Sai Shilpitha Janga, MD, David Glass, DO, Kyra Herman, DO, Erkanda Ikonomi, MD, Angela Frates, MD. P6269 - Let Down Your Hair, Rapunzel - A Unique Case of Wernicke Encephalopathy in the Setting of Rapunzel Syndrome, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
