THE RAPUNZEL SYNDROME

(Warning: this is a gross-out.)

CASE HISTORY: a 12-year-old girl is brought to the school nurse complaining of abdnominal pains, nausea, and a feeling that her stomach is “full.” She has had these symptoms for four months. The nurse examines the girl’s belly and feels a soft mass in the left upper abdomen. Then she spots the vital clue that leads to the diagnosis: a large bald patch on the girl’s head.

Stumped? Here’s a hint: It’s something she ate.

The girl suffers from a rare but fascinating medical condition known as a trichobezoar. In laymen’s terms, she has a hairball in her stomach.

Bezoars are large masses of indigestible organic matter which are eaten and then get trapped in the stomach. They can be caused by vegetable or fruit fiber (phytobezoars) or by the ingestion of hair (trichobezoars). They are most commonly found in animals. The ancients, in fact, believed that such masses from the stomach of goats possessed magical healing properties, and the word “bezoar” comes from an Arabic word meaning “antidote.”

When gastric hairballs occur in humans, the patients are usually children or mentally disturbed women who yank out their own hair and swallow it. A partially bald scalp is an obvious clue. As in a plugged shower drain, the hairs get trapped and tangled in the stomach, accumulating over time, until they cause distension, bloating, and nausea. Long strands from the hairball may extend past the stomach, all the way through the small intestine, and may even reach the colon, a condition known as The Rapunzel Syndrome.

If you’ve ever fished out a hairball from a plugged shower drain, then you know just how disgusting and smelly they can be. The same can be said for trichobezoars. They are traps for undigested fat and havens for bacteria. That, plus the chronic exposure to gastric juices, makes the matted hairballs turn black and nauseatingly odorous.

Smaller bezoars can often be treated with drugs, digestive enzymes, or shock wave fragmentation. The big ones, though, will usually require the surgeon’s scalpel.