Courtesy RobotconscienceThe New England Journal of Medicine featured a brief but interesting story this last week. A very interesting story. A little human biology, a little Harry Potter style magic, a ton of hair. Really, a wonderful story indeed.
It’s a story I like to call Rapunzel and Poisoner’s Stone.
It seems that a previously healthy 18 year old had, for several months, been suffering from intense abdominal pain, a certain amount of abdominal distention, and had lost about 40 pounds. A physical examination revealed a “firm, tender” mass near the stomach, but was largely unremarkable. X-rays showed the mass as well, but there was no obstruction of the digestive tract. It wasn’t until the doctors pulled out their longest word, “esophagogastroduodenoscopy,” that the mystery began to reveal itself. For a more detailed description of esophagogastroduodenoscopy, click here, but essentially it’s where a snaky little camera is shoved down your throat into your stomach.
As the esophagogastroduodenoscopy probe passed through the convulsing, dank corridor of the esophagus into the dark chamber of the stomach, this is what the operator saw: a hairball. Nay, not just a hairball, a hair monster, a mighty trichobezoar.
A bezoar, you will recall (if you think back to first year Defense Against the Dark Arts), is the “stone from stomach of a goat which will protect from most poisons.” Or, more accurately, it is a concretion most often found in the stomachs of ruminant animals (like goats, cows, etc.), and, in fact, will do very little to protect you from poison. While some bezoars may be able to bind compounds of arsenic, they probably still aren’t going to be much help in a Princess Bride style battle of wits. There’s an interesting 16th century account of a wealthy French surgeon who was studying the properties of bezoars when he found out that his cook had stolen some of his silverware. The cook agreed to be poisoned as punishment. After giving the cook the poison, the surgeon used a bezoar on him. The cook died in agony several days later.
Bezoars from humans, like in the case described above, are a little different, and a little more rare. Often the human bezoars are composed of compacted hair, eaten by the sufferer. The hair is usually consumed intentionally and compulsively, a condition known as trichophagia. The whole thing is often referred to as Rapunzel syndrome.
The Rapunzel in this case had a trichobezoar that weighed… TEN POUNDS! It was 15 inches by 7 inches by 7 inches! A ten pound mystical hairball in her stomach! Oh ho! Bleh!
Five days after the removal of the bezoar, the woman was eating normally and was discharged from the hospital. She has since regained 20 pounds and has stopped eating her own hair.