pica and Abdomen--Acute

To review the general surgical management of mentally handicapped persons with pica.. A study of hospital records and a review of the current literature.. A community hospital.. Thirty-five patients from a large institution for the mentally handicapped were treated for well-documented pica on 56 occasions at the Orillia Soldiers Memorial Hospital between 1976 and 1991.. Endoscopy and laparotomy for the removal of foreign bodies or to close perforations.. Fourteen (25%) cases of pica were managed by observation only, but 42 (75%) cases required surgical intervention. There were 34 laparotomies. The complication rate was 30% and the death rate 11%.. Pica is a serious health risk for mentally handicapped patients. Diagnosis and postoperative care can be difficult. Pica should be suspected in mentally handicapped patients with gastrointestinal symptoms.

Topics: Abdomen, Acute; Adolescent; Adult; Digestive System Surgical Procedures; Disabled Persons; Female; Foreign Bodies; Gastric Outlet Obstruction; Humans; Intellectual Disability; Intestinal Obstruction; Intestinal Perforation; Intestine, Small; Laparotomy; Male; Middle Aged; Ontario; Peritonitis; Pica; Retrospective Studies; Survival Rate

Lead colic is a rare cause of abdominal pain. The diagnosis of lead poisoning is most often mentioned in at risk populations (children, psychotic). We report the case of a 2 year old child that was presented for acute abdomen. Abdominal plain radiograph showed multiple intra-colonic metallic particles and suggested lead poisoning diagnosis. Anamnesis found a notion of pica and consumption of peeling paint. Elevated blood lead levels (BLL) confirmed the diagnosis. The lead poisoning is a public health problem especially in children, but its manifestation by a lead colic is rare and could simulate an acute abdomen table.

Topics: Abdomen, Acute; Abdominal Pain; Child, Preschool; Colic; Humans; Lead; Lead Poisoning; Male; Paint; Pica; Radiography, Abdominal

Topics: Abdomen, Acute; Adolescent; Anemia, Iron-Deficiency; Female; Humans; Pica

Intellectually-disabled patients with acute abdominal conditions are susceptible to late diagnosis and adverse outcome due to impaired communication, altered behaviour, neurological impairment, associated congenital anomalies, variable reaction to pain and drugs and various difficulties in perioperative management. The present study aims to present the experience of surgery for acute abdominal conditions in intellectually-disabled patients. Various difficulties encountered during the management are highlighted and measures to overcome these problems are discussed.. A prospective descriptive population study was performed through the prospective collection of data on consecutive intellectually-disabled adults operated for acute abdominal conditions over a 5-year period. Study parameters included demographic details, clinical presentation, diagnostic modalities, operative findings and outcome in terms of morbidity and mortality.. Of 19 men and three women with a mean age of 28.3 years, anorexia, vomiting, and increasing abdominal distension were the most common presenting features. History of pica was available in 36.4% of patients. Intestinal obstruction, acute appendicitis, volvulus and pseudo-obstruction of the colon were the most frequently encountered conditions. Postoperative morbidity and mortality were 33 and 23%, respectively.. Intellectually-disabled patients demand particular clinical expertise owing to various difficulties inherent to their mental and physical disabilities. Short history, anorexia, vomiting and abdominal distension should make the clinician aware of the possibility of an acute abdominal condition. History of pica should be considered a serious clinical correlate. A high index of clinical suspicion, intensive perioperative care and low threshold for an early operation are recommended to reduce the higher morbidity and mortality figures.

Topics: Abdomen, Acute; Acute Disease; Adult; Appendicitis; Colonic Pseudo-Obstruction; Comorbidity; Female; Humans; Intellectual Disability; Intestinal Obstruction; Male; Pica; Postoperative Complications; Prospective Studies

Topics: Abdomen, Acute; Adult; Diarrhea; Digestive System Surgical Procedures; Female; Foreign Bodies; Humans; Intestine, Small; Ischemia; Pica; Treatment Outcome; Vomiting

Topics: Abdomen, Acute; Abscess; Colonic Diseases; Female; Humans; Intestinal Perforation; Middle Aged; Peritonitis; Pica; Sigmoid Diseases; Soil

Pica is a pathologic craving for substances not commonly regarded as foods. In this study the authors report their experience about five cases presented with an acute abdomen following foreign bodies ingestion by patients mentally handicapped. Therapeutic treatment was emergency laparatomy with postoperative morbidity of 40% and mortality of 40%. It is hoped that specific drug therapy with more aggressive surgical treatment will reduce the mortality significantly.

Topics: Abdomen, Acute; Adolescent; Adult; Emergencies; Fatal Outcome; Female; Foreign Bodies; Humans; Male; Middle Aged; Pica; Psychotic Disorders

Two cases of geophagia (dirt eating) that were diagnosed radiographically are presented. The clinical presentation mimicked urgent surgical conditions. The characteristic radiographic appearance provided a major clue to the correct diagnosis. An intense clinical history is often necessary to reach the specific diagnosis and properly manage the condition.

Topics: Abdomen, Acute; Adolescent; Aged; Female; Humans; Male; Pica; Radiography; Soil