Rapunzel syndrome in a 16-year-old girl without noticeable hair loss or bald patches: a case report

Background Trichotillomania is a disorder consisting of repetitive hair pulling due to a strong urge to do so with a sense of relief after. Trichophagia is closely related to trichotillomania and involves the eating of hair that has been pulled out. It is estimated that only 1% of patients with trichophagia go on to develop a trichobezoar, a bezoar made of hair. Trichobezoars are formed when the hair strands get stuck within the folds of the gastric wall and eventually form a ball as the hair accumulates. Case presentation A 16-year-old Caucasian girl was transferred to our hospital with vomiting and a suspected gastrointestinal (GI) obstruction. Upon an abdominal computed tomography (CT) scan, it was discovered that she had a large bezoar spanning her stomach and duodenum which was surgically removed due to inability to reach it with a scope. It was found to contain hair and after interviewing the patient a diagnosis of trichotillomania was made. There was no noticeable hair loss on the patient. The psychiatry team started her on sertraline 25 mg with a referral for CBT once discharged from the hospital. Conclusions This patient represents a unique case in that her condition began 2 years ago and has been stable in severity ever since it began. This case demonstrates the importance of having this disease on the differential diagnosis even for those who do not have another clear mental illness and who do not meet the usual criteria of psychiatric causes. Given that trichobezoars have the potential to be very dangerous, and sometimes even deadly, it is important to not overlook this diagnosis in an adolescent female with nausea, vomiting, or abdominal pain even in the absence of noticeable hair loss or a coexisting psychiatric disorder.