The Rapunzel Syndrome

26 Jul

Bet you’ve never heard of this. Neither had I. The Rapunzel Syndrome is an extremely rare condition with less than two dozen cases being reported. It is part of the larger group of conditions we call pica syndromes.

Pica is the repetitive eating of non-food items. Some of these are cultural (clay eating) while others are associated with various psychiatric disorders such as schizophrenia and severe Obsessive-Compulsive Disorder (OCD). These people consume things such as paper, paint chips, dirt, chalk, coins, rubber bands, paper clips and other metallic objects, hair, clay, almost anything you can think of. Clay eating is a type of geophagia–geo means earth and phagia means eating. It is not a rare occurrence, particularly in the south, since it is thought to be healthy to do so. It can lead to constipation and even bowel rupture, but most commonly causes anemia since the clay inhibits the absorption of iron from the GI tract. Paint chips were a common cause of lead poisoning in children until laws changed, requiring indoor paint to be lead free. Still some older buildings have leaded paint, maybe painted over a few times but still there, so that when the paint peels the leaded layer can be exposed and consumed.

Wikipedia Pica Article

Some of these ingested materials can form a ball known as a bezoar, the same thing your cat coughs up. This can be anything from a hard ball of clay to a tightly wound wad of hair. It can cause intestinal obstruction and intestinal erosions with bleeding and perforation. Both of these can be life-threatening and often require surgical treatment.

When hair is eaten, known as trichophagia (tricho means hair; phagia means to eat), it can form a hair ball (trichobezoar) in the stomach. This can cause the obstruction and erosions mentioned above, usually near the bottom of the stomach in the area known as the gastric outlet–where the stomach empties into the small bowel. Rarely the bezoar will form a long tail that extends downstream into the small bowel. This long tail of hair is reminiscent of Rapunzel’s hair in the Grimm Brothers famous fairy tale.

This tail can cause obstruction or erosion of the small bowel and can lead to death if not treated surgically in a timely manner. A recent article published Forensic Science International reports on the death of a child from this syndrome. Just under four years old, she appears to be the victim of neglectful abuse and is considered the youngest victim of this rare syndrome ever reported.

Medicine is filled with bizarre syndromes and this is definitely one of them.

Wikipedia Rapunzel Syndrome Article


5 responses to “The Rapunzel Syndrome

  1. Caroline Young

    July 26, 2009 at 10:54 am

    A hundred years ago, my aunt used to chew on chips left over from sidewalk material that lay on the ground in Bowling Green, OH. Her doctor told the family she “must need the lime.” She didn’t get sick from it, but her younger sister (my mother) walked 20 feet behind on the way to school, so she wouldn’t have to hear the chewing.


  2. Caroline Young

    July 26, 2009 at 10:54 am



  3. Eloise

    July 26, 2009 at 11:23 am

    Dr. Lyle,

    Loved the article!

    I worked in same-day surgery for many years and we had a number of patients with bezoars as well as those who had equally stange things removed from their feet—i.e., cat fur, toe nails, and human hair that had walled off into a cyst.

    I’ve also seen my share of man made objects that required removal, but that’s a subject for another day 🙂


  4. Mayurakhsi Sanghvi

    September 28, 2012 at 3:19 pm

    Howdy would you mind sharing which blog platform you’re using? I’m going to start my own blog soon but I’m having a hard time making a decision between BlogEngine/Wordpress/B2evolution and Drupal. The reason I ask is because your layout seems different then most blogs and I’m looking for something completely unique.
    P.S Apologies for getting off-topic but I had to ask!



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