Hair apparent: Rapunzel syndrome.

Emily (all names and identifiers have been changed to protect confidentiality) was a 7-year-old girl seen by her pediatrician for a routine annual examination. Although Emily had voiced no complaints, her mother had noted that she had appeared paler than usual. Upon physical examination, her pediatrician noted a nontender palpable mass in the child’s stomach, leading him to order an abdominal ultrasound. The study showed no evidence of any abnormalities, although the technician did note that Emily must have just eaten because her stomach was full. However, her mother reported that Emily had not eaten since breakfast, 4 hours earlier. On reevaluation the next day, Emily’s pediatrician still palpated the same mass, leading him to order a computed tomography (CT) scan of the abdomen. The abdominal CT demonstrated a free-floating mass that filled the entire stomach and was surrounded by a thin rim of contrast material (Figure 1). Emily’s pediatrician did not think the mass was consistent with a neoplasm but was concerned that it could be a conglomeration of something she had ingested. Upon further questioning, Emily reported no stomach pain, nausea, vomiting, reflux, diarrhea, flatulence, recent illnesses, or fever. Her mother reported no change in her bowel habits and stated that Emily never wanted to eat much in one sitting.