A nine-year-old girl in Kerala has undergone surgery after doctors found a large mass of hair blocking her digestive tract. Doctors at NIMS Medicity near Neyyattinkara removed around 1 kg of hair from her stomach and small intestine after she was brought to the hospital with persistent abdominal pain and vomiting. An ultrasound and CT scan showed severe intestinal obstruction, while an endoscopy confirmed a large accumulation of hair in the stomach and small intestine. The girl was diagnosed with Rapunzel syndrome, a rare condition in which a mass of swallowed hair, known as a trichobezoar, grows in the stomach and extends into the small intestine.

The entire hairball was removed, after which the child recovered well, started eating normally and was discharged from the hospital. Hospital authorities said fewer than 100 cases of the condition have been reported worldwide.

What Is Rapunzel Syndrome?

Rapunzel syndrome is an extremely rare form of trichobezoar, which is a solid mass made up of hair that has accumulated inside the stomach. It develops when a person repeatedly swallows hair, which is a behaviour known as trichophagia. Because human hair cannot be digested, it can remain in the stomach and gradually build up into a hard mass.

In Rapunzel syndrome, the hair mass does not stay limited to the stomach. It develops a tail-like extension that passes through the opening of the stomach and into the small intestine. This can eventually block the movement of food and digestive contents.

What Causes Rapunzel Syndrome?

The condition is strongly linked to trichotillomania, and trichophagia. Trichotillomania is a disorder wherein a person repeatedly feels the urge to pull out their own hair, and trichophagia is a condition wherein the pulled or loose hair is swallowed. These behaviours can occur alongside psychological or emotional difficulties, although not every person with hair-eating behaviour has an underlying psychiatric disorder.

Over time, repeatedly swallowed hair can collect in the stomach because it cannot be broken down or digested. More hair gradually gets trapped in the existing mass, making it larger and harder. In some cases, the mass eventually extends into the small intestine, resulting in Rapunzel syndrome.

Symptoms To Watch Out For

The symptoms can vary depending on the size and location of the hairball. Common symptoms include:

  • Abdominal pain: A child may complain of persistent or recurring stomach pain
  • Nausea and vomiting: A large hair mass can interfere with the normal movement of food
  • Loss of appetite: A child may feel full quickly or avoid food
  • Weight loss: Poor intake and problems with digestion can lead to unexplained weight loss
  • Constipation or diarrhoea: Changes in bowel movements may occur
  • Bad breath: A large hairball can sometimes be associated with persistent bad breath
  • Signs of intestinal obstruction: Severe pain, repeated vomiting and inability to pass stool or gas can indicate a blockage
  • Bloating: The abdomen may feel swollen or uncomfortable

What Are The Complications That Can Happen?

If the hairball becomes large, it can cause stomach or intestinal obstruction, preventing food and digestive contents from moving normally. Prolonged obstruction can lead to dehydration, nutritional deficiencies and weight loss. In severe cases, the pressure and irritation caused by the mass can lead to ulcers, bleeding, intestinal perforation or peritonitis, which is a serious infection inside the abdomen.

How Is The Condition Treated?

Doctors may use ultrasound, CT scans and endoscopy to identify a trichobezoar and determine whether it has extended into the intestine. Endoscopy can sometimes be used to remove smaller hairballs, but very large masses or those causing obstruction generally require surgery. Surgery involves removing the hair mass from the stomach and, when necessary, the intestine. Once the physical obstruction is treated, it is also important to address the behaviour that led to repeated hair pulling or swallowing. Psychological assessment, behavioural therapy and follow-up can help reduce the risk of the hairball forming again.

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