A woman in Pakistan agonized for months over stomach problems, from vomiting to constipation, before realizing the culprit behind her ailments was a giant hairball in her stomach.
The 38-year-old woman was diagnosed with Rapunzel syndrome, named after the fairy tale character, in a case published in the journal BMJ Case Reports.
The large hairball measured 15×10 centimeters. A second hairball, measuring 4×3 centimeters, was also discovered. Both were removed via surgery, and the patient left the hospital six days later.
“This patient suffered with trichotillomania for many months and was diagnosed very late with severe complications of Rapunzel syndrome,” said Faiz Anwer, director of the Adult Blood and Marrow Transplant Program at Banner University Medical Center in Tucson, Arizona.
The disorder is related to trichotillomania and a disorder known as trichophagia. Trichotillomania is characterized by an irresistible urge to pull out one’s hair, while trichophagia is known as the compulsive eating of hair.
Rapunzel syndrome develops when one sucks on his/her own hair and swallows it. Over time, the hair builds up and clogs the digestive tract. The hair can come from any part of the body.
Testing on the patient proved to be a dead end and doctors decided to operate, discovering the patient’s hairballs. The case report’s summary explained the results of what tests were able to be conducted.
“Laboratory investigations revealed low serum protein levels,” the summary said. “Laparotomy was performed, and a hairball was removed from her stomach and ileum.”
The woman’s symptoms included unintentional weight loss, loss of appetite and nausea. She also complained of constipation and had an enlarged abdomen due to accumulating gas and fluids. She was reported to look tired and unhealthy.
The woman was provided with nutritional support and access to a psychiatrist.
“Almost all cases reported in the published medical literature from all over the world regarding this disease required treatment with surgery,” said Anwer. He said he hopes doctors will look for early signs of the syndrome and to address it if they think it is present.
Rapunzel syndrome was found to be linked to complications including pancreatitis, stomach ulcers, anemia and peritonitis.
“We performed a comprehensive search and summarized data for a total of 88 cases. No time or language limit was placed,” the summary said. “The purpose of this discussion was to highlight the clinical spectrum of Rapunzel syndrome and also to report its rare association with hypoproteinemia.”
In another case of Rapunzel syndrome, a 5-year-old girl was originally misdiagnosed with intussusception, a condition in which part of the intestine telescopes into itself.
No evidence of the hairball was present before surgery, and it was removed upon discovery. Other symptoms did include abnormal gas and a hole in the intestine.
The girl was psychologically evaluated, and no recurrence was found after six months, according to the case report’s summary.
Robert King, an American Psychiatric Association member, said trichotillomania is seen mostly in children and adolescents.
“Some kids pull their hair out and mouth the hair and of those, a small number even swallow them,” he said. “Very often it’s a form of self-soothing. It’s associated often with kids who have some anxiety.”
Tori Linville is a freelance writer and editor from Clarksville, Tennessee. When she isn’t writing or teaching, she’s faithfully watching her alma mater, the University of Alabama, dominate the football field.
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