Hair resists digestion and is not easily moved through the digestive system. As such, it often gets stuck in folds of the stomach wall, denatures, and then traps food and gunk to form a mass. Over time, the material will continue to collect and grow into a thick, matte wad.
Of all the bezoars, trichobezoars are the most common. But none of them are particularly easy to spot. On CT scans, bezoars may be indistinguishable from food in the stomach unless oral contrast material is present. To look for a possible bezoar in the teen, her doctors ordered an esophagogastroduodenoscopy, in which a scope is placed through the mouth into the stomach. This gave them a clear picture of the problem: a trichobezoar. (The image is here, but a warning: it is graphic).
Confused tail
But this trichobezoar was extremely rare; the spotted mat's hair dangled from the stomach into the small intestine, which is an extremely unusual condition called Rapunzel Syndrome, named after the fairy tale character who lets down her long hair. In addition to acute abdominal pain, it carries a host of complications, including perforation of the stomach and intestines and acute pancreatitis. The only solution is surgical removal. In the teen's case, the trichobezoar came out during surgery using a gastrostomy tube. Surgeons found a hairball about 2.5 inches wide, along with dangling hair reaching into the small intestine.
For any patient with a trichobezoar, the most important next step is to address any psychiatric disorders that may underlie hair eating behavior. Hair eating is often associated with a condition called trichotillomania, a repetitive behavioral disorder characterized by hair pulling. Sometimes the condition can be diagnosed by signs of hair loss: bald spots, irritated scalp areas or hair in different stages of growth. But for the most part, it is an extremely difficult condition to diagnose because patients have significant shame and embarrassment about the condition and will often go out of their way to hide it.
Another possibility is that the teen had pica, a condition characterized by persistent eating of nonfood, nonnutritive substances. Intriguingly, the teen noted that she had pica as a toddler. But doctors were skeptical that pica could explain her condition, since hair was the only non-food material in the bezoar.
The teenager's doctors were keen to get to the bottom of her condition and referred her to a psychiatrist after she successfully recovered from surgery. But unfortunately, she didn't return for follow-up care and told her doctors that she would instead see a hypnotherapist her friends recommended.
