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Extremely Rare 'Rapunzel Syndrome' Can Cause a Hairball So Large It Requires Surgery
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- DeepHorus
A 16-year-old girl underwent emergency surgery to remove an extremely rare and life-threatening "Rapunzel Syndrome," a hairball that had grown large enough to obstruct her entire digestive tract. The case, detailed in the Journal of Medical Case Reports, highlights the potential severity of hair-pulling and eating disorders, even when external signs are absent.
Trichotillomania, the compulsive pulling of one's hair, is sometimes paired with trichophagia, the eating of the pulled hair. Hair is primarily composed of keratin, which human digestive enzymes cannot break down, allowing it to accumulate into a solid mass called a trichobezoar. In the most severe form, known as Rapunzel Syndrome, the hairball can extend through the stomach and into the small intestine.
The patient presented at the hospital with persistent vomiting. A CT scan revealed the large hairball spanning her stomach and duodenum. Crucially, she had no history of psychiatric illness, no visible hair loss, and was meeting normal developmental milestones, making the diagnosis unexpectedly challenging for the medical team.
Surgery was required because the mass was too large to be removed with an endoscopic scope. Post-operatively, the girl admitted to pulling and eating approximately three hairs once a week for two years, a habit she had successfully concealed. She reported no recent trauma, abuse, or other stressors, though she had a history of migraines and cyclic vomiting.
The case underscores a major diagnostic pitfall. Social stigma often leads patients to hide these behaviors, and the absence of common warning signs like baldness or known psychiatric conditions can delay life-saving treatment. The authors stress the importance of considering trichobezoars in adolescents with unexplained gastrointestinal symptoms.
Following the procedure, the patient was prescribed sertraline and referred for cognitive behavioral therapy. This case serves as a critical reminder for clinicians to maintain a high index of suspicion for this rare but dangerous condition, regardless of a patient's external presentation or disclosed history.
