Hair is resistant to digestion and does not pass easily through the digestive system. As a result, they often get stuck in the folds of the stomach lining and degenerate, trapping food and gunk and forming lumps. Over time, it continues to collect material and grows into a thick, matte mass.
Of all bezoars, trichobezoars are the most common. But none of them are particularly easy to find. On a CT scan, bezoars may be indistinguishable from food in the stomach unless oral contrast is used. To find out whether the teen might have bezoar stones, doctors ordered an esophagogastroduodenoscopy, in which an endoscope is inserted through the mouth and into the stomach. This gave them a clear picture of the cause of the problem – caterpillars. (The image is hereBut be warned: it’s graphic).
tangled tail
However, this trichobezoar was particularly rare. Hair dangled from a speckled mat, falling from his stomach into his small intestine. This is an extremely rare condition called Rapunzel syndrome, named after the fairy tale character who wore her long hair down. In addition to acute abdominal pain, it is associated with many complications, including perforation of the stomach and intestines, and acute pancreatitis. The only solution is surgical removal. In the case of a teenage boy, demodectic mange came out during surgery using a gastrostomy tube. Surgeons recovered a hair bulb about 2.5 inches wide and dangling hairs that reached into the small intestine.
The most important next step for people with demodectic mange is to address any mental illness that may be underlying the hair-eating behavior. Eating hair is often associated with a condition called trichotillomania, a repetitive behavior disorder characterized by hair pulling. In some cases, the disorder may be diagnosed by signs of hair loss, such as bald spots, scalp inflammation, and hair in various stages of growth. However, diagnosis is very difficult because in most cases, patients feel a great deal of shame and embarrassment about the condition and often go to great lengths to hide it.
Another possibility is that this teenage boy suffered from pica, a disorder characterized by the continuous eating of non-food, non-nutritive substances. Interestingly, this teenage girl discovered that she had pica as a toddler. But doctors were skeptical that pica could explain her condition, given that it was the only non-food substance in her stomach.
The teen’s doctors wanted to fully understand her condition and would have referred her to a psychiatrist once she had successfully recovered from surgery. Unfortunately, she did not return for follow-up, instead telling her doctor that she was going to see a hypnotherapist recommended by a friend.
