Rapunzel syndrome

Rapunzel syndrome is the medical name for an extremely rare condition in which a mass of swallowed hair forms a trichobezoar — a hairball — in the stomach, with a long “tail” of hair extending downward into the small intestine. The name was coined in 1968, and it is one of medicine’s more literary diagnoses.^{[citation needed]}

How a person ends up with a hairball

Cats get hairballs from grooming. People are not supposed to get them at all, because people are not supposed to eat hair. The condition almost always begins with trichophagia, the compulsive eating of one’s own hair, which frequently accompanies trichotillomania, a disorder of compulsive hair pulling. The great majority of reported cases are in young women.

Hair is made of keratin, the same tough, largely indigestible protein found in nails and horn. The stomach cannot break it down, and its slippery surface keeps strands from passing through. So the hair stays, catches more hair, traps food and mucus, and slowly felts itself into a dense mass that can take the shape of the stomach itself.

The Rapunzel part

In most hairball cases the mass simply sits in the stomach. Rapunzel syndrome is the dramatic version: the trichobezoar grows a tail long enough to thread through the stomach outlet and trail into the intestine, like a braid let down from a tower. By the time it is discovered, the mass can weigh a great deal and has often been growing for years.

Symptoms creep in slowly — a vague fullness, nausea, weight loss, a stomach that feels permanently occupied because it is. Because the cause is so unexpected, it is frequently missed until imaging reveals a stomach-shaped object that should not be there.

Treatment

Small bezoars can sometimes be broken up, but a full Rapunzel-style mass is usually too large and too matted, and the standard fix is surgical removal. The lasting cure, though, is treating the underlying compulsion — otherwise the tower simply grows a new braid.

See also

• Do hair and nails grow after death?
• Keratin, the protein that refuses to be digested
• Trichotillomania