BMJ Case Reports 2016; doi:10.1136/bcr-2016-216600

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

  1. Faiz Anwer4
  1. 1University of Arizona, Tucson, Arizona, USA
  2. 2Griffin Hospital, Derby, Connecticut, USA
  3. 3Department of Medical Education, Griffin Hospital, Derby, Connecticut, USA
  4. 4Department of Hematology Oncology, University of Arizona Medical Center, Tucson, Arizona, USA
  1. Correspondence to Dr Faiz Anwer, anwerf{at}
  • Accepted 12 September 2016
  • Published 26 September 2016


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.

Register for free content

The full text of all Editor's Choice articles and summaries of every article are free without registration

The full text of Images in ... articles are free to registered users

Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and develop this resource

Don't forget to sign up for content alerts so you keep up to date with all the case reports as they are published, and let us know what you think by commenting on the Editor's blog

Navigate This Article