Rapunzel Syndrome Caused Teen To Develop Hairball So Big It Perforated Her Stomach

Hair can't be digested so when ingested it can form a mass. Image credit: Quality Stock Arts/Shutterstock.com

In Ricky Gervais’s series Afterlife, his character Tony describes humans as “chimps with brains the size of planets.” It’s a relatable concept for some who find themselves overwhelmed by the unending bad news we’ve been exposed to over the past year or so, on top of any personal struggles, and such stress can lead to counterintuitive behaviors from eating disorders to picking at our hair or skin.

Dermatophagia and trichotillomania are two conditions linked to psychological distress, people can also develop a rarer condition known as Rapunzel Syndrome brought on by trichophagia, which is when a person eats their own hair. While consuming an individual hair is unlikely to cause any harm, swallowing a lot of this surprisingly hardy material can wreak havoc on your digestive system and even be fatal.  

If lots of hair makes it into our stomachs, something called a trichobezoar can form which is essentially a big furball made of human hair and gut mucus. Hair is made of a densely packed protein called keratin which can’t be broken down in the same way that food is processed in our digestive system. As such, the hair just sits there and the more you eat the bigger the matted ball can become.

A paper in BMJ Case Reports describes one such trichobezoar, which had grown to such a size it actually perforated the stomach of a 17-year-old. The patient had presented to the emergency department having experience episodes of fainting and when examined was found to have a mass in her abdomen.

The physicians on her case ordered a contrast-enhanced CT scan which showed the enormous hairball that had ruptured the stomach and caused fluid to gather in the abdominal cavity. Fortunately, the patient had a successful operation to remove the trichobezoar and repair the damage done, and the patient was followed up with psychiatric care while they recovered.

rapunzel syndrome
The trichobezoar was squashed into shape by the stomach walls. Image courtesy of BMJ Case Reports 2021

“Though uncommon, bezoars should be included in our differential diagnosis as they can present in various ways owing to their size and weight,” wrote the authors. “This case illustrates the risk of gastric perforation with large gastric bezoars.”

A healthy abdomen is usually soft, symmetrical, and not painful, so discomfort or lumps are always worth getting checked out. There are a number of common and benign conditions which can cause fleeting episodes of gastric upset, but every now and then case reports turn up rare and unusual conditions.

One such case report detailed a 17-year-old whose abdominal mass turned out to be her parasitic twin. A CT scan showed a "fat density areas, soft tissue and multiple calcified density components of various sizes and shapes resembling the shape of vertebrae, ribs and long bones." From this, she was diagnosed with "fetus in fetu,” an extremely rare abnormality where a fetus becomes enveloped by its own twin. Less than 100 cases have ever been recorded worldwide, with the abnormality happening in only one per 500,000 births.

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