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A 16-year-old girl compulsively ate so much of her own hair that surgeons had to remove a giant, shoe-sized hairball from her stomach.

The hairball weighed 500g – the same as a block of butter – and measured 30cm long, the same as a size 12 men’s shoe.

The rare case has been highlighted in a New Zealand Medical Journal report, “Laparoscopic retrieval of large gastric trichobezoar”, published today.

Doctors and staff connected to the case at Tauranga Hospital said the girl presented with pain and nausea, before an X-ray showed an abnormally swollen abdomen and signs of a bezoar – a tightly packed collection of undigested material that becomes stuck in the digestive tract – later identified to be a large hairball.

A superficial gastric ulcer had also developed inside the girl’s stomach.

The teen had a background of trichotillomania – a disorder characterised by the constant urge to pull out hair.

The condition is also closely associated with trichophagia – an equally rare compulsive disorder when a person eats hair.

“A young female developed a giant hairball in her stomach (gastric trichobezoar) due to compulsive hair-pulling and hair eating,” said the report.

“Trichobezoars are rare gastric foreign bodies composed of ingested hair, occurring predominantly in young females with trichotillomania and trichotillophagia.”

In some cases, the problem can lead to a condition known as Rapunzel syndrome. This occurs when the hairball in the stomach develops a tail that extends into the small intestine.

In such a rare occurrence, the report said, complications could include obstruction, perforation and even pancreatitis.

Images provided in the report include that of the large J-shaped hairy mass, with a standard 30cm ruler just beneath it, as an indication of measurement. The photo is titled: “Figure 3: Trichobezoar, weighing 500g.”

Two other images are included in the report.

One was an abdominal X-ray showing “an intragastric mass with a mottled gas pattern, consistent with a trichobezoar”.

The other image is taken during the operation to remove the hairball and treat the superficial gastric ulcer.

One of the report writers includes the surgeon who operated on the teen, Dr Binura Lekamalage, who was involved in another shocking case last year.

In a case published in the NZ Medical Journal last October, a 13-year-old boy had to have part of his intestines removed after admitting to swallowing 100 high-power magnets he bought from the popular online store Temu.

Lekamalage could not be contacted for comment on this latest case.

The report said that given the hairball’s size and density, chemical dissolution and endoscopic extraction were unsuitable.

“This condition is usually managed with surgery involving a large incision (laparotomy) rather than minimally invasive key-hole surgery, because of the risk of contaminating the abdomen.

“We used a hybrid approach with key-hole surgery and small incision (mini-laparotomy) to remove the hairball, which was effective.”

The report said the hybrid approach had the benefits of minimally invasive surgery while also reducing the risk of contamination.

A follow-up gastroscopy appointment – during which a thin, flexible camera tube is used to examine the stomach and small intestine – was carried out eight weeks after the teen’s surgery.

“Follow-up ... confirmed healing of the gastric ulcer.”