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BMJ Case Rep. 2016 Sep 26;2016. pii: bcr2016216600. doi: 10.1136/bcr-2016-216600.

Rapunzel syndrome: a rare cause of hypoproteinaemia and review of literature.

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University of Arizona, Tucson, Arizona, USA.
Griffin Hospital, Derby, Connecticut, USA.
Department of Medical Education, Griffin Hospital, Derby, Connecticut, USA.
Department of Hematology Oncology, University of Arizona Medical Center, Tucson, Arizona, USA.


Rapunzel syndrome is an extremely rare condition associated with trichophagia (hair eating disorder) secondary to a psychiatric illness called trichotillomania (hair-pulling behaviour). It is most commonly seen in children and adolescents. Untreated cases can lead to a number of complications. We present a case of a middle-aged woman with sudden intractable vomiting and constipation associated with bilateral pedal oedema and significant weight loss. Laboratory investigations revealed low serum protein levels. Laparotomy was performed, and a hairball was removed from her stomach and ileum. The patient was managed with the help of a psychiatrist and was given nutritional support. We performed a comprehensive search and summarised data for a total of 88 cases. No time or language limit was placed. The purpose of this discussion is to highlight the clinical spectrum of Rapunzel syndrome and also to report its rare association with hypoproteinaemia.

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