Rapunzel syndrome: hair ingestion and the need for follow-up care

The brief in 4 cards

1. Context1 / 4

   A one-kilogram mass of hair was surgically removed from the stomach and small intestine of a child in Kerala, in a case reported on 3 October 2026.

   Persistent abdominal pain and vomiting led to hospital admission. Ultrasound and computed tomography scans showed intestinal obstruction. Endoscopy confirmed a large hair mass. The child recovered, resumed eating and was discharged.

   The condition was Rapunzel syndrome, named after the long-haired fairy-tale character. It illustrates how repeated hair ingestion can produce a serious physical complication. Assessment of the behaviour and appropriate follow-up are important alongside treatment of the obstruction.

2. Key concepts2 / 4

   These terms describe different aspects of the condition.

   • Bezoar: A mass of indigestible or poorly digestible material trapped in the gastrointestinal tract.
   • Trichobezoar: A bezoar made of hair, which resists digestion and can accumulate in the stomach.
   • Rapunzel syndrome: A stomach trichobezoar with an extension through the pylorus into the small intestine. It can cause obstruction, perforation or bleeding.
   • Trichophagia: Eating or swallowing hair. Trichotillomania refers to recurrent pulling out of one's own hair.

   1. Why does hair accumulate?

   Hair contains keratin and resists digestion. Strands can become trapped in stomach folds and collect with mucus and food. Repeated ingestion can enlarge the mass over time.

   2. How common is it?

   Rapunzel syndrome is rare. Published case counts differ and do not establish a reliable population prevalence. Hair-pulling does not always involve hair-eating, and hair-eating does not always produce a bezoar.

   3. Who is usually affected?

   Published cases often involve girls and young women, including adolescents. Younger children and males can also be affected. A psychiatric or behavioural condition may coexist, but it needs individual assessment.

   4. How is it treated?

   Large hair masses extending into the intestine often need surgery. Endoscopic removal may be possible in selected smaller cases. Mental-health assessment and continuing follow-up help address the behaviour and recurrence risk.

3. Way forward3 / 4
   • Assess physical and behavioural symptoms together. Persistent abdominal pain, vomiting or hair loss may warrant clinical assessment. Clinicians can ask sensitively about hair-pulling and hair-eating; these signs alone do not establish a diagnosis.
   • Provide early support. Paediatric services and school health programmes can help recognise concerns and arrange appropriate referral.
   • Plan continuing care. Removal of the mass should be linked to assessment of the underlying behaviour, appropriate psychological treatment and supportive family involvement. Avoid blame or stigma.
   • Connect public services. The District Mental Health Programme (DMHP) provides community mental-health services, including early detection, treatment and school counselling activities. Tele Mental Health Assistance and Networking Across States (Tele MANAS) provides remote mental-health support and links to further care.

   These service connections can support access, but a telephone consultation does not replace in-person assessment or surgical care when required. Strengthening referral and follow-up is a proposed public-health response.

4. Note4 / 4

   

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