Rapunzel Syndrome: Trichotillomania, Trichophagia & Trichobezoar

Rapunzel Syndrome, Intestinal Obstruction, Trichotillomania (Hair pulling Disorder), trichophagia (Hair Eating Disorder), trichobezoar
Rapunzel is the long-haired princess from the famous German fairy tale. But this channel is not about fairy tales, but about interesting medical cases. Trust me when I say this is going to be as interesting as a fairy tale. Please allow me to tell the tale of Rapunzel Syndrome, the rare psychiatric disorder which can end up being fatal.
There’s a psychiatric disorder called Trichotillomania or hair-pulling disorder. Patients with this disorder have a compulsion to pull out their hair.
Some of these patients may even swallow the pulled hair. When they do that, they fall into another related psychiatric disorder named trichophagia or hair eating disorder.
Unfortunately for these patients, humans cannot digest hair. The swallowed hair solidifies in the stomach and forms into a hard mass. This hard mass of hair is called the trichobezoar.
Its head is usually situated in the stomach, but the tail may extend into the small intestine
This solidified hair can cause ulcerations in the walls of the stomach or obstruction of the intestines.
When there’s ulceration or intestinal obstruction, bacteria in the gut can translocate into the abdominal cavity and cause an infection called peritonitis. This can lead to a potentially life-threatening condition called septic shock and cause multi-organ failure.
Doctors will perform an upper GI endoscopy to diagnose the Rapunzel syndrome. But to determine the extent of the mass, a CT scan of the abdomen should be performed.
Surgery is the treatment of choice to remove masses of hair. After the surgery, trichophagia or hair eating disorder should be treated with habit reversal training. In this treatment method, patients are trained to resist the impulse to pull or eat hair.
Females are more likely to develop this condition and the mortality rate may extend from 15% to 30%.

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