10-year-old girl with Rapunzel syndrome has 10-oz. hairball surgically removed from her stomach

One hell of a haircut.

Doctors in Pune, India, recently operated on a 10-year-old girl to remove a 10-oz. hairball, equivalent in size to a roll of paper towels, from her stomach.

The child was diagnosed with “Rapunzel syndrome,” a rare digestive disorder caused by the compulsion to pull out and consume one’s own hair.

Over time, these indigestible strands combine with mucus and food in the stomach to form a mass of hair, known medically as a trichobezoar.

Left untreated, these masses can extend into the small intestine, leading to infection, obstruction, ulceration, and nutritional deficiencies.

In this latest case, the tail-like mass of hair and cotton extended from the child’s stomach into her small intestine and gallbladder.

“She had been experiencing intermittent abdominal pain for nearly ten months, with no relief from conservative treatment,” said Kalpesh Patil, paediatric and neonatal laparoscopic surgeon, who led the surgical team.

“She was admitted to our hospital on Oct 8. Clinical examination revealed a large, hard mass palpable across the upper abdomen. “

Over the course of the 2.5-hour emergency procedure, Patil and his team successfully removed the giant hairball. He noted that even among cases of Rapunzel syndrome, the presence of hair in the gallbladder is unheard of.

Rapunzel syndrome itself is extremely rare, with fewer than 100 cases reported since the condition was classified in 1968.

Rapunzel syndrome typically affects females between the ages of 13 and 19.

Patil stressed the importance of early diagnosis of psychological conditions that cause Rapunzel syndrome, including anxiety, OCD and depression, as well as the need for post-op psychiatric treatment to prevent the development of another hairball.

“Along with surgery and follow-up treatments, we have recommended a psychiatric evaluation for the girl,” he said. “While recurrence is rare, it is possible, especially if the psychiatric disorder remains untreated.”

After surgery, the young patient was admitted to the pediatric ICU, and after confirmation that there were no leaks from the GI tract, oral feeding began.

A week after surgery, she passed a tangle of threads in her stool, which Patil explained is likely residual material from her intestinal tract.

She is now stable, tolerating food, and was discharged on Oct 29.

Rapunzel syndrome is caused by a combination of trichotillomania (obsessive hair pulling from the same spot on the body) and trichophagia (a mental health condition associated with the sucking, chewing, or eating of one’s hair).

The hair is typically pulled from the scalp and swallowed.

Both trichotillomania and trichophagia are rare; between 0.5 and 3% of people will experience trichotillomania during their lifetime.

Of these cases, an estimated 10% to 30% are accompanied by trichophagia, according to LiveScience.

A 2019 study noted that, of those who suffer from both disorders, only 1% will develop a hairball in the gastrointestinal tract.

However, the condition is as dangerous as it is unusual.

In 2021, a British teen developed a foot-and-a-half-long hairball that tore through her stomach.

The hairy specimen had grown so large that, upon surgical removal, doctors discovered the trichobezoar had “formed a cast of the entire stomach.”

In 2017, another British teen died from complications of Rapunzel syndrome when a hairball in her stomach triggered a bacterial infection, eventually leading to a burst ulcer that caused her organs to shut down.