Rapunzel syndrome

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Rapunzel syndrome is an extremely rare intestinal condition in humans resulting from ingesting hair (trichophagia).[1][2] The syndrome is named after the long-haired girl Rapunzel in the fairy tale by the Brothers Grimm. Trichophagia is sometimes associated with the hair-pulling disorder trichotillomania.[3] This syndrome is a rare and unusual form of trichobezoar.[4]

Signs and symptoms[edit]

The use of the Rapunzel syndrome first appeared in the literature in 1968.[5]

Characteristics of the syndrome include:

  • The body of a trichobezoar (hairball) located in the stomach, and its tail (hence the reference to Rapunzel in the syndrome's name) in the small bowel and/or in the right colon
  • Small or large bowel obstruction
  • Occurring in psychiatric patients
  • Trichotillomania

Rapunzel Syndrome is caused by indigestion of hair.


Trichobezoar can be preoperatively diagnosed. However, the diagnosis of the Rapunzel syndrome has to consider several aspects such as the patient's history with disorders like Trichophagia and Trichotillomania.[6][7]

The diagnosis of the syndrome is also done by endoscopy. A CT scan is recommended to determine the size and the extension of the trichobezoar.[5]


Because the human gastrointestinal tract is unable to digest human hair, the trichobezoar may have to be treated surgically. Patients usually also require psychiatric evaluation and treatment due to the association with impulse control disorders, especially trichotillomania.[8]


  1. ^ Sah DE, Koo J, Price VH (2008). "Trichotillomania" (PDF). Dermatol Ther. 21 (1): 13–21. doi:10.1111/j.1529-8019.2008.00165.x. PMID 18318881. 
  2. ^ Ventura DE, Herbella FA, Schettini ST, Delmonte C (2005). "Rapunzel syndrome with a fatal outcome in a neglected child". J. Pediatr. Surg. 40 (10): 1665–7. doi:10.1016/j.jpedsurg.2005.06.038. PMID 16227005. 
  3. ^ Chamberlain SR, Menzies L, Sahakian BJ, Fineberg NA (April 2007). "Lifting the veil on trichotillomania". Am J Psychiatry. 164 (4): 568–74. doi:10.1176/appi.ajp.164.4.568. PMID 17403968. 
  4. ^ Gonuguntla, Veena; Joshi, Divya-Devi (2009). "Rapunzel Syndrome: A Comprehensive Review of an Unusual Case of Trichobezoar". Clinical Medicine & Research. 7 (3): 99–102. doi:10.3121/cmr.2009.822. ISSN 1539-4182. PMC 2757434Freely accessible. PMID 19625498. 
  5. ^ a b Maloney, William James (2014-09-22). The Medical Lives of History`s Famous People. Bentham Science Publishers. ISBN 9781608059362. 
  6. ^ Wang, Zhe; Cao, Feng; Liu, Diangang; Fang, Yu; Li, Fei (2016-11-22). "The diagnosis and treatment of Rapunzel syndrome". Acta Radiologica Open. 5 (11). doi:10.1177/2058460115627660. ISSN 2058-4601. PMC 5122172Freely accessible. PMID 27900201. 
  7. ^ Wang, Zhe; Cao, Feng; Liu, Diangang; Fang, Yu; Li, Fei (2016-11-22). "The diagnosis and treatment of Rapunzel syndrome". Acta Radiologica Open. 5. doi:10.1177/2058460115627660. 
  8. ^ Gorter RR, Kneepkens CM, Mattens EC, Aronson DC, Heij HA (May 2010). "Management of trichobezoar: case report and literature review". Pediatr. Surg. Int. 26 (5): 457–63. doi:10.1007/s00383-010-2570-0. PMC 2856853Freely accessible. PMID 20213124. 

Further reading[edit]