Bizarre discovery stuns doctors during teen’s surgery

By Julia Ries | Fact-checked by Davi Sherman
Published January 20, 2025

Key Takeaways

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  • “The symptoms often present as stomach pain, vomiting, feeling full, and nausea for Rapunzel, which is likely confused for a digestive condition." - Bryan Bruno, MD, ​​a board-certified psychiatrist and Medical Director of Mid City TMS in New York City

  • “As the hairball grows, it obstructs the normal digestive process, irritates the stomach lining, and sometimes extends into the small intestine,” says Po-Chang Hsu, MD, a physician and medical content expert at Alpas Wellness.

A 16-year-old girl was recently admitted to Massachusetts General Hospital, where she was diagnosed with a rare condition called Rapunzel syndrome.[] She’d been experiencing abdominal pain, nausea, and vomiting for 4 weeks, but previous CT scans and blood testing results appeared normal, according to the case study, which published in The New England Journal of Medicine

The patient was prescribed painkillers and an anti-nausea medication, but her symptoms continued to worsen, and a couple of weeks later, she returned to the hospital with an elevated heart rate and severe abdominal pain. The doctors evaluated her for various gastrointestinal conditions, including constipation, gastritis, postviral gastroparesis, gallbladder disease, pancreatitis, and Celiac disease, but the results again appeared normal. 

Finally, an esophagogastroduodenoscopy identified a trichobezoar—a mass of undigested hair. The girl was diagnosed with Rapunzel syndrome, a rare intestinal condition that can occur when people eat their own hair. 

Here’s what causes Rapunzel syndrome—and why it’s easily mistaken for other conditions.

What is Rapunzel syndrome?

Rapunzel syndrome is a rare problem that typically occurs in people who suffer from a psychiatric condition called trichotillomania, which causes people to feel an irresistible urge to pull out their own hair.[][] It may also be related to other mental health conditions like post traumatic stress disorder or affective disorders, some research suggests.

Hair is not easily digested, so it can accumulate within the gastric mucosa. Over time, it can turn into a mass lodged within the stomach. “As the hairball grows, it obstructs the normal digestive process, irritates the stomach lining, and sometimes extends into the small intestine,” says Po-Chang Hsu, MD, a physician and medical content expert at Alpas Wellness.

Many people remain asymptomatic for years. Eventually, however, Rapunzel syndrome can cause a host of symptoms, including bad breath (halitosis), abdominal pain, nausea and vomiting, and peritonitis. “The symptoms often present as stomach pain, vomiting, feeling full, and nausea for Rapunzel, which is likely confused for a digestive condition,” Bryan Bruno, MD, ​​a board-certified psychiatrist and Medical Director of Mid City TMS in New York City, tells MDLinx

The intestinal blockage may also lead to nutrient deficiencies. Some patients, for example, have developed an iron deficiency or a vitamin B12 deficiency, research shows.[]

How can trichotillomania can lead to Rapunzel syndrome

According to the case report, the patient said she didn’t have trichotillomania. But due to the shame and stigma associated with the condition, people often go to great lengths to hide it. Therefore, the clinicians didn’t rule out trichotillomania. 

“Trichotillomania is classified as a body-focused repetitive behavior disorder characterized by recurrent hair-pulling, leading to noticeable hair loss and significant distress,” says Maria Rheba Estante, LMFT, a psychotherapist with Open Mind Health. It’s relatively rare, affecting roughly 1% to 2% of the population worldwide, but estimates suggest that 50% to 70% of people with trichotillomania have oral ritualistic behaviors, ie, they rub hair across their lips or bite the root of their hair. “This behavior is often rooted in stress, anxiety, or other emotional factors,” Dr. Hsu says.

It’s also estimated that trichophagia occurs in about 5% to 20% of people with trichotillomania.[] And though this statistic is likely underestimated, trichobezoars are found in 1% of individuals with trichotillomania. 

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