“Rapunzel, Rapunzel, let down your hair” is the famous fairytale cry. | iStock
Contents
Rapunzel syndrome is an extremely rare form of trichobezoar in humans resulting from trichotillomania (irresistible urge to pull out hair) & trichophagia (compulsively eating hair).
Clinical features
Body of a trichobezoar (hairball) located in the stomach, and its tail (hence the reference to Rapunzel in the syndrome’s name) in small bowel and/or in right colon
Small/large bowel obstruction
Occurring in psychiatric patients
Trichotillomania
A stomach-shaped trichobezoar with a tapering tail extending into the small bowel is surgically removed en bloc. | Gonuguntla, V., & Joshi, D.-D. (2009). Rapunzel Syndrome: A Comprehensive Review of an Unusual Case of Trichobezoar. Clinical Medicine & Research , 7(3), 99–102. https://doi.org/10.3121/cmr.2009.822
This large gastric trichobezoar extended from the stomach to the cecum. It was originally discovered as an “incidental” finding on a CT for acute appendicitis. It was removed in a separate procedure, after the patient re-gained weight. [The bezoar was acting as a bariatric device, suppressing the patient’s appetite.] | Organ System. (2018) MedPix Case – Rapunzel Syndrome (Gastric Bezoar extending to cecum). Retrieved August 17, 2018, from https://medpix.nlm.nih.gov/case?id=869c604b-1a7c-446f-a5a6-50dbbdf33d8f
Diagnosis
Patient’s history (disorders like Trichophagia and Trichotillomania)
Endoscopy
CT scan (determine the size and the extension of the trichobezoar)
Management
Surgery (as GIT unable to digest human hair)
Psychiatric evaluation and treatment (due to the association with impulse control disorders, especially trichotillomania)
