Rapunzel Syndrome - Gastric Trichobezoar (Hairball) אכילת שיער ופקעת שיער

The Rapunzel Syndrome is a variant of gastric trichobezoar, where the hairball extends out of the stomach and into the small bowel. In this 9 y.o. girl, the bezoar, forms an almost perfect cast of the stomach, and extends through the pylorus toward the fourth (ascending) portion of the duodenum. The gastric acid denatures the hair protein, causing the dark color - as compared to the portion in the duodenum.
CME Link - http://rad.usuhs.edu/medpix/cow_image.html?mode=cow_viewer&pt_id=10834&imageid=35702&quiz=yes&this_week=693#history