A clinician may gently examine different regions of the abdomen, looking for tenderness, swelling, guarding, or an unusual mass.
They may listen for bowel sounds and evaluate whether the abdomen appears distended.
General observations can also be important.
Signs of dehydration, pallor, weakness, weight loss, or poor growth may influence the investigation.
A teenager who has experienced months of poor appetite may need assessment of nutritional status, particularly if the discomfort has reduced normal food intake.
In some cases, doctors can detect a palpable abdominal mass.
However, not all masses can be felt through the abdominal wall, and the absence of an obvious lump does not rule out a digestive condition.
Similarly, a normal examination does not guarantee that every possible cause has been excluded.
It means that the findings must be interpreted alongside the medical history and any other available evidence.
Blood tests and other laboratory investigations
Laboratory testing may help identify inflammation, anemia, infection, nutritional deficiencies, or other abnormalities.
For example, a complete blood count can provide information about red and white blood cells.
Low hemoglobin may suggest anemia, which can occur for a variety of reasons and requires further interpretation.
Tests measuring inflammation may sometimes support the investigation of certain diseases, although they cannot identify a trichobezoar by themselves.
Depending on the situation, clinicians may also assess kidney and liver function, electrolyte balance, urine findings, or conditions such as celiac disease.
Not every teenager needs all of these investigations.
Doctors choose tests based on symptoms and clinical findings rather than ordering every available procedure automatically.
This principle helps reduce unnecessary discomfort, cost, and confusion.
The role of ultrasound and medical imaging
When a structural problem is suspected, imaging can provide valuable information.
Ultrasound is frequently useful in children because it creates images using sound waves rather than ionizing radiation.
It can help clinicians assess certain abdominal organs and investigate possible causes of pain.
Nevertheless, ultrasound has limitations.
Gas within the intestines, the patient's anatomy, and the location of an abnormality can affect what is visible.
An inconclusive ultrasound does not necessarily mean that nothing is wrong.
Computed tomography, commonly called a CT scan, creates detailed cross-sectional images of the body.
CT imaging can help identify certain masses, obstructions, inflammatory processes, and other abnormalities.
However, it exposes patients to ionizing radiation, so doctors carefully consider its benefits and risks, especially for children and adolescents.
Magnetic resonance imaging, or MRI, may provide an alternative for some conditions without using ionizing radiation.
The National Institute of Diabetes and Digestive and Kidney Diseases describes ultrasound, CT, and MRI as tools clinicians may use when evaluating abdominal conditions such as appendicitis, with the choice influenced by patient characteristics and clinical needs.
The central lesson is that imaging should answer a specific medical question.
An investigation is most useful when doctors understand what they are looking for and how the result will affect treatment.
When an endoscopy may be necessary
For certain stomach conditions, doctors may recommend an upper gastrointestinal endoscopy.
During this procedure, a specialist passes a thin, flexible instrument with a camera through the mouth and into the upper digestive tract.
The procedure allows doctors to examine the lining of the esophagus, stomach, and first part of the small intestine.
It can help identify inflammation, ulcers, bleeding, foreign material, or unusual masses.
In some cases, instruments passed through the endoscope can also retrieve or break apart material.
For a suspected bezoar, endoscopy may provide direct confirmation of what the mass contains.
But endoscopy does not always offer an effective method of removal.
A large, densely packed trichobezoar may be difficult to fragment or extract safely through the endoscope.
If the material is too large or extends into the intestine, surgical treatment may be necessary.
The Merck Manual notes that management depends on the bezoar's composition, size, symptoms, and associated complications.
Merck Manual Professional Edition
Why surgery sometimes becomes the safest option
The decision to operate is never based solely on how unusual an object looks in a photograph.
Doctors consider whether the patient's condition can be managed safely through less invasive means.
Surgery may become necessary when a mass creates an obstruction, causes complications, or cannot be removed adequately through endoscopy.
In some cases, surgeons may use minimally invasive techniques involving small incisions and specialized instruments.
In others, especially when a mass is very large or complicated, an open surgical procedure may be more appropriate.
The operation may involve opening the stomach to remove the accumulated material and then carefully closing the surgical opening.
Surgeons also assess surrounding tissues and may examine the intestine for additional material or complications.
The exact approach depends on the individual patient.
It would be inappropriate to assume which procedure the reported 14-year-old underwent without verified medical documentation.
What is clear from published cases is that surgical removal can be an effective treatment for significant trichobezoars.
For example, a case report published in BMJ Case Reports described a patient with Rapunzel syndrome whose large hair mass was removed through abdominal surgery after it caused partial obstruction of the stomach's outlet.
Such reports demonstrate that the condition is medically real, although they do not establish the circumstances of the viral story.
Recovery involves more than removing the mass
Successful surgery addresses the immediate physical problem, but recovery may require additional care.
Doctors monitor patients for complications, assess pain control, and determine when food and fluids can be safely resumed.
If poor nutrition, anemia, dehydration, or other problems developed before treatment, these may need to be addressed.
Follow-up appointments help clinicians assess healing and recognize any returning symptoms.
When a trichobezoar is linked to hair-eating behavior, attention to the underlying behavior is especially important.
Removing the existing mass does not necessarily prevent another from developing if the contributing behavior continues.
A multidisciplinary team may therefore include pediatricians, surgeons, gastroenterologists, mental health professionals, dietitians, and family caregivers.