A 23-year-old woman with a history of an eating disorder complains of vomiting, nausea, and severe abdominal pain. Physical examination shows abdominal distension and constipation. An X-ray film of the abdomen reveals air-fluid levels and a hyperlucent shadow at the epigastric area. The material obstructing the gastrointestinal tract is removed surgically and shown. Which of the following is the most likely diagnosis?

Bezoars are foreign bodies in the stomach that are composed of food or hair that have been altered by the digestive process. The mass removed from the stomach in this patient is a hairball (trichobezoar) within a gelatinous matrix. Trichobezoar is usually seen in long-haired girls or young women who eat their own hair as a nervous habit (trichotillomania; also called "Rapunzel" syndrome). Such a trichobezoar may grow by accretion to form a complete cast of the stomach. Strands of hair may extend into the bowel as far as the transverse colon (Rapunzel syndrome). Phytobezoars (choice C) are concretions of plant material, which usually occur in persons with conditions that interfere with gastric emptying.Diagnosis: Trichobezoar, bezoar, Rapunzel syndrome