Father brings his 14 year girl with complaints that she is unable to eat, dull stomach pain and she is growing weak. I looked at this skinny girl. She appeared malnourished. Her height was shorter and she was thin for her age. I looked directly at her eyes but she was avoiding direct contact. I caught her hand to gain her confidence. I asked her some simple questions like her school’s name, etc. She initially was reluctant to answer but slowly she started to respond to my questions. During my course of discussion with her, I realized that she had lot of anger build up in her self. She was not dumb but was quiet smart. I made her lie on the examination cot. I saw that she suffered from malnutrition and vitamin deficiencies. I put my hand on her thin tummy to feel her inside organs. I found that she had a hard lump in upper part of her abdomen. The lump was large and relatively mobile. Besides the blood investigations, I specifically ordered for an ultrasound of her abdomen.
Father – daughter came back with reports next week. The sonologist found a large mass in her stomach. It was so large that it was filling up her stomach completely. I was feeling sorry for this girl – she was surely in trouble. I asked her father to get her CT scan done. He was reluctant. He said he did not have enough money. He had four children and he was the sole bread earner. Also, he was worried about the treatment cost. I assured him that I will try my best to assist him in his difficult financial situation. I advised him to get her CT scan done in a Government hospital and gave him all necessary directions.
A week latter they came back with the CT scan report. The child seem not happy with me as I had made her undergo a major test. Poor child. She stay in Mumbai slums. She was small and skinny. She had to sleep on the CT scan gantry in a cold environment with a big hi-tech machine going over her. The CT scan confirmed my diagnosis – a huge hair ball in her stomach. It was so big that it was not only occupying her whole stomach but distended it so much that it appeared that she had a big feast! Now how did such a huge collection of hair occur in her stomach? The hair ball in stomach was ten times larger than the amount of hair that she had on her head! I took his father in confidence and asked her about her behavior. He told me that she has a habit of anger feats. She gets angry over small issues and in the feat of anger she pulls her hair ( medically called Trichotillomania) and many times eats it (medically called Trichophagia). She has developed this habit since childhood. This made things clear. Being the smallest child and probably unwanted and mistreated she had developed a psychological habit of pulling her hair and eating it. The father was also appearing angry on her. I had a long discussion with her father and realized that for his the child was a burden and now a trouble as he has to spend money for her treatment.
I made a call to the administration of the hospital. Convinced them that this was a genuine case and the child needed help. If help was not given the father would probably leave the child to her fate. The hospital social worker took up her case and told the father to deposit a extremely small sum of money and the hospital will take care of the rest by arranging donors for her treatment.
The child was admitted, surgery performed next day and she was discharged form the hospital after five days. The father was extremely thankful to me for arranging everything for the treatment. From a doctor I became a friend for the girl. I had kept the hair ball specimen next to her bed in a preservative. Everyday I would council her. She promise that she will never swallow hair again. Her father also agreed that he will try his best to treat her nicely.
Ten days latter, I removed the last stitches from her body. The child had started to eat properly & gain weight. Now the next problem I anticipate is will the father have enough money to feed her? Before she was not eating much and now the child was eating normally. Would the father have enough money to feed her?
Read more about Trichotillomania, Trichophagia, Trichobezoar, Rapunzel Syndrome and view my operation photos.
Dr. Bimal Shah is the senior most General & Laparoscopic surgeon in Mira – Bhayandar with largest series of operations. He also consults at Borivali – Dahisar. He believes in ethical practice & is available at only trust hospitals. He passed out from KEM hospital, Mumbai in 1993 and was a lecturer training newer surgeons & medical students till 1998. 
