Rapunzel syndrome hairball

Two giant hairballs had to be removed from a woman's stomach as a result of an extremely rare condition – Rapunzel syndrome. The psychiatric disorder is associated with trichophagia, where people compulsively eat their own hair, and trichotillomania, where people have an urge to pull out their own hair.

The name Rapunzel syndrome comes from long-haired character in the Brothers Grimm fairy tales. The condition is highlighted in BMJ Case Reports.

The woman, who was 38 at the time, visited doctors after the sudden onset of vomiting and constipation. She suffered significant weight loss, having shed 15lbs over eight months. She had lost her appetite and her abdomen had become enlarged. She had no history of psychiatric disorders and had never been hospitalised.

Rapunzel syndrome hairball
The 10x15cm hairball found in the woman's stomach BMJ Case Reports 2016

A number of tests were carried out but all came back inconclusive. Because of her worsening condition, doctors were unable to carry out more tests. They suspected she had an obstruction in her abdomen because of a mass or abdominal tuberculosis.

As a result, they decided to operate. During surgery they found two huge hairballs. The largest measured 10x15cm and was found in her stomach with "a small tail in the first part of the intestines". The second, measuring 4x3cm, was found in the third portion of the intestines.

Rapunzel syndrome hairball
The smaller hairball removed from the intestine BMJ Case Reports 2016

The patient was discharged from hospital six days after surgeons removed the hairballs. She was provided with psychiatric support and given nutritional advice.

Following the surgery, doctors identified her condition as Rapunzel syndrome. They found 88 other cases where the disorder resulted in complications – highlighting its rarity.