A 16-year-old girl’s mysterious gastrointestinal illness turned out to have an especially hairy culprit behind it. Doctors discovered that a giant hairball stuck in her stomach was the cause of her problems.
The girl’s doctors detailed the real life tale of body horror in a paper published this week in the New England Journal of Medicine, as part of a regular segment highlighting unusual cases that pass through the halls of the Massachusetts General Hospital in Boston. The case is a rare example of a known condition called Rapuznel syndrome, one that can have life-threatening complications if not caught early enough. While the girl did have to endure weeks of worsening symptoms before the discovery was made, the doctors were able to successfully remove her hairball with no issues.
According to the report, the girl and her family visited a local emergency department four weeks after she began experiencing occasional bouts of vomiting and stomach pain that eventually became excruciating (when asked to rate her pain on a scale from 1 to 10, she responded 8). Her initial check-up failed to find any clear cause for her illness, and she was sent home with medications to treat the symptoms. The medications did little to soothe her pain, which at times would wake her up from sleeping. Following more weeks of continued illness, which included a second trip to the same ED that yielded no answers, the girl was finally seen by the doctors at Mass General.
Given the lack of other explanations, and the fact that her symptoms often lessened right after she vomited, her doctors eventually suspected that she had gastric outlet obstruction, a condition caused by a physical blockage between the stomach and small intestine. Often, this blockage is from a bezoar, a medical term for any mass of foreign material that gets trapped in the body, but which is usually made of hair or fiber.
To find out for sure, the doctors sent down a tube and camera to examine her upper gastrointestinal tract, and that’s when their suspicions were confirmed. The girl had a hefty trichobezoar (hairy bezoar) in her stomach that had started to tangle its way into the small intestine. While some trichobezoars are so big that they can only be removed surgically from the body, the doctors were able to safely extract the hair that extended into the small intestine and remove the girl’s hairball through the tube alone. (For those with an NEJM subscription, here’s a link to the picture, but fair warning: It’s quite gnarly.)
Hairballs in humans are usually caused by trichophagia, a form of disordered eating in which people feel compelled to swallow their hair. Trichophagia tends to be accompanied by trichotillomania, or the compulsion to pull out one’s own hair. But when interviewed, the girl denied that she pulled her hair. Though there have been rare cases of trichobezoars not tied to trichotillomania, the doctors note that people often feel shame about having the condition and may not admit to it, so it’s still possible that this was the root cause of her hairball. Thankfully, the girl’s physical recovery went smoothly, with no lingering stomach pain reported a month later. And while she did decline a referral to a psychologist made by the doctors, she told them that she was planning to see a hypnotherapist recommended by her friends.
Cases of Rapunzel syndrome are rare, but amazingly enough, this isn’t the first one to make waves in 2024. Earlier this July, doctors in Ecuador reported extracting a two-pound hairball from a woman’s stomach.
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