pica and Abdominal-Pain

The pica phenomenon, where non-edible substances are repeatedly consumed, has been linked with developmental and behavioural disorders, particularly autism. The clinical presentation of foreign body ingestion in patients with autism is discussed, and recommendations for caregivers are provided based on the available literature. An 18-year-old man with severe autism and behavioural difficulties presented with a vague history of decreased appetite and melaena of eight months duration. Foreign body ingestion commonly occurs in individuals with autism spectrum disorders and should be suspected in patients who present with vague gastrointestinal symptoms. The adverse medical and surgical consequences of foreign body ingestion emphasize the need for early recognition. Surgical intervention for foreign body ingestion can prevent complications. Magnetic substances can cause considerable gastrointestinal morbidity and require urgent endoscopic or surgical removal. Primary prevention is also vital.

Topics: Abdominal Pain; Adolescent; Autistic Disorder; Caregivers; Foreign Bodies; Humans; Magnetics; Male; Metals; Pica; Stomach; Tomography, X-Ray Computed

Topics: Abdominal Pain; Diagnosis, Differential; Female; Gastrointestinal Diseases; Humans; Male; Pica; Pregnancy; Risk Factors

The authors describe a patient with chronic renal failure who developed intestinal obstruction from talcum powder pica. A literature review found 43 previously reported cases of surgical complications caused by various forms of pica. Most occurred in women, blacks, aborigines, children, or the mentally retarded--all groups in whom pica occurs more frequently than the general population. Intestinal obstruction was the most common clinical presentation and the ileum most often the site of obstruction reported at surgery. Perforation with peritonitis was the next most common presentation but three cases of colon perforation were diagnosed only at surgery or postmortem. Mixed pica (paper, plastic bags, cloth, string) seemed more likely to require surgery and to cause perforation. An accurate preoperative diagnosis was made most often when a history of pica was sought, and opacity on abdominal X rays correctly interpreted. These clues to pica as the underlying cause of abdominal complaints should not be neglected in patients who are members of the groups known to be at higher risk of this compulsive eating disorders.

Topics: Abdominal Pain; Adult; Colonic Diseases; Female; Humans; Intestinal Obstruction; Kidney Failure, Chronic; Kidney Transplantation; Pica

Trichobezoars are rare, but most commonly found in young women with trichophagia and trichotillomania. Complications can include iron deficiency anaemia and gastric erosion or, rarely, perforation. A 19-year-old woman presented with epigastric pain, vomiting and lethargy. Initial investigations revealed a palpable abdominal fullness on examination and iron deficiency anaemia. Oesophagogastroduodenoscopy found a large trichobezoar associated with gastric erosions, polyps and an ulcer. Subsequently, the patient reported previous consumption of artificial hair extensions, which ceased 5 years previously. Attempts to remove the trichobezoar by endoscopy were ineffective and in line with current literature, laparotomy was successful. This case describes a rare cause of trichobezoar and emphasises the importance of appropriate initial investigations and definitive management.

Topics: Abdominal Pain; Bezoars; Endoscopy; Female; Hair; Humans; Laparotomy; Pica; Vomiting; Young Adult

Topics: Abdominal Pain; Adult; Anemia, Iron-Deficiency; Depressive Disorder; Diagnosis, Differential; Female; Hemoglobins; Humans; Lead; Lead Poisoning; Menorrhagia; Pica; Vomiting

Iron deficiency anemia (IDA) and abdominal pain are commonly seen in a pediatric emergency department (8 and 18% incidence respectively in our center). They are manifestations of a wide variety of diseases ranging from benign to immediately life-threatening. Trichobezoar is an under-diagnosed entity that has to be considered in children and adolescents, expecially female, suffering from trichotillomania (compulsion to pull hair) and trichophagy (compulsion to swallow hair). When undiagnosed, gastric bezoars may cause gastric ulceration, perforation, haemorrhage and obstruction.. To underline the importance of including this pathology in the differential diagnosis of IDA and abdominal pain, we present the case of a 14 year-old girl with a huge trichobezoar which completely filled the stomach and extended into the small bowel. Since trichobezoar has an extension to the small bowel, it is classified as Rapunzel syndrome. As the bezoar couldn't be removed by endoscopy, the girl underwent surgical intervention. The patient passed through a gradual re-feeding, with iron and vitamins supplementation, and through a psychiatric counselling.. The Rapunzel syndrome is a rare entity that may be complicated by life-threatening events. A prompt diagnosis and an appropriate therapy can reduce comorbidities. Gradual re-feeding with supplementation of micronutrients allows adequate catch-up weight with normalization of haematochemical nutritional parameters. Since many of these patients suffer from psychiatric pathology such as PICA with emotional problems and mental retardation, psychological/psychiatric counselling plays an important role in order to prevent bezoar recurrence.

Topics: Abdominal Pain; Adolescent; Anemia, Iron-Deficiency; Bezoars; Diagnosis, Differential; Duodenum; Emergency Service, Hospital; Female; Humans; Pica; Stomach; Syndrome; Tomography, X-Ray Computed; Trichotillomania; Ultrasonography

Topics: Abdominal Pain; Bezoars; Dilatation, Pathologic; Foreign Bodies; Humans; Intestinal Obstruction; Male; Middle Aged; Pica; Schizophrenia

Topics: Abdominal Pain; Cognitive Dysfunction; Constipation; Foreign Bodies; Heart Arrest; Humans; Male; Middle Aged; Pica; Rectal Diseases

Topics: Abdominal Pain; Adolescent; Appendicitis; Conversion to Open Surgery; Female; Humans; Ileal Diseases; Intestinal Obstruction; Laparoscopy; Pica; Severity of Illness Index; Tomography, X-Ray Computed

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: Abdominal Pain; Adolescent; Bezoars; Constipation; Female; Gastric Outlet Obstruction; Hair; Humans; Pica; Stomach

Voluntary running in an activity wheel establishes aversion to paired taste in rats. A proposed mechanism underlying this taste aversion learning is gastrointestinal discomfort caused by running. We tested this hypothesis by measuring the pica behavior (kaolin clay intake) of rats, because it is known that rats engage in pica behavior after various nausea-inducing treatments including irradiation, motion sickness, and injection of emetic drugs such as lithium chloride (LiCl). Following a demonstration of the already-known phenomenon of LiCl-based pica in Experiment 1, we successfully showed running-based pica behavior in Experiment 2 where the running treatment was compared with a non-running control treatment (i.e., confinement in a locked wheel). These results suggest that not only LiCl but also running induces nausea in rats, supporting the gastrointestinal discomfort hypothesis of running-based taste aversion learning.

Topics: Abdominal Pain; Aluminum Silicates; Animals; Avoidance Learning; Behavior, Animal; Clay; Disease Models, Animal; Dysgeusia; Emetics; Injections, Intraperitoneal; Kaolin; Lithium Chloride; Male; Models, Biological; Motor Activity; Nausea; Physical Exertion; Pica; Rats, Wistar; Stress, Physiological

Geophagia, eating of earth, is a relative frequent practice in several countries and especially in the African and South American mainlands. In some cases, migrant people continue this practice in the host country. Geophagia has some positive effects, presumed or real, and several harmful effects with significant health impacts. We relate the history of young patient of Cameroonian origin who consults for chonic fatigue, abdominal pain and menorrhagia. Laboratory tests show a severe aneamia with iron deficiency.

Topics: Abdominal Pain; Adult; Anemia, Iron-Deficiency; Cameroon; Fatigue; Female; Ferric Compounds; Hematinics; Humans; Injections, Intravenous; Menorrhagia; Pica; Poverty; Risk Factors; Switzerland; Treatment Outcome

Children and adolescents with sickle cell disease demonstrate an increased incidence of pica. Pica involving polyurethane foam has been previously reported, but effective management of such cases remains unclear. We present the case of a 17-year-old African American adolescent girl with sickle β+ thalassemia who presented with a long history of foam rubber pica resulting in intestinal obstruction. Conservative management was unsuccessful, and the patient ultimately required operative intervention. We advocate for a low threshold for early operation in cases of foam rubber bezoar.

Topics: Abdominal Pain; Adolescent; beta-Thalassemia; Bezoars; Depression; Female; Heterozygote; Humans; Ileal Diseases; Ileum; Intestinal Perforation; Peritonitis; Pica; Polyurethanes; Radiography; Sickle Cell Trait; Zinc

The case of a 64-year-old patient with pica and severe mental retardation who was admitted to our hospital for treatment of recurrent cholecystitis is reported. Abdominal ultrasound showed sludge in the gallbladder, but no stones. Abdominal CT revealed a foreign body in the duodenum resembling a suction cup of the type commonly used in kitchens and bathrooms. The object could not be removed because it was deeply embedded in the hypertrophic intestinal mucosa. A nasogastric tube was inserted for feeding, since the object impeded the passage of solid foods. The patient's fever and abdominal pain subsequently resolved, and laboratory data improved. The indwelling feeding tube prevented recurrence of cholecystitis. Since pica is common not only in patients with mental retardation but also in dementia patients, the present case may also relate to the treatment of acute abdominal conditions in dementia patients.

Topics: Abdominal Pain; Cholecystitis; Duodenum; Female; Fever; Foreign Bodies; Humans; Imaging, Three-Dimensional; Intellectual Disability; Intubation, Gastrointestinal; Middle Aged; Pica; Recurrence; Tomography, X-Ray Computed; Treatment Outcome

A 37-year-old man was admitted to hospital after complaining of abdominal pain for the past two weeks. On admission the abdominal radiograph showed multiple radio-opaque flecks dispersed throughout the gastrointestinal tract. Blood testing showed hemoglobin level 8.7 g/dL and a blood lead level of 112.4 microg/dL. The family interview revealed that the patient had pica-like behavior since childhood. He was a site foreman and had been ingesting pieces of roofing plates for a few weeks. The patient was treated with laxatives and CaNa(2)EDTA therapy was initiated. The blood lead level then dropped to 69.9 microg/dL. The patient received two subsequent courses of oral succimer and the blood lead level decreased to 59 microg/dL 21 days after the first course. The follow-up abdominal X-ray 20 days after the first examination was normal. Four months later, an outpatient follow-up visit showed a blood lead level within normal limits (14.5 microg/dL) and a psychiatric follow-up was initiated. Lead poisoning following the ingestion of lead-containing foreign bodies is particularly rare in adults, while it is sometimes observed in children. Pica behavior is a well-identified risk factor of lead intoxication in children but is quite exceptional in adults, where it is usually considered to be a psychiatric condition. Other unusual sources of lead poisoning include the ingestion of lead bullets, ceramic lead glaze or glazed earthenware, lead-contaminated candies, ethnic or herbal remedies.

Topics: Abdominal Pain; Adult; Bone Diseases; Chelating Agents; Edetic Acid; Electromyography; Humans; Laxatives; Lead; Lead Poisoning; Leukemia; Male; Neuropsychological Tests; Pica; Radiography

A case of small bowel obstruction in a 4-year-old boy with pica is described. The child habitually chewed on his plastic toy action figures. Abdominal radiography and endoscopy confirmed the presence of chewed pieces of plastic within the digestive tract. At surgery, the cause of the obstruction was found to be an internal hernia involving a congenital fibrous band connecting 2 segments of the jejunum and unrelated to pica. Intestinal obstruction caused by foreign bodies is extremely rare, and obstruction caused by congenital bands is even more uncommon. This particular variant of a congenital band has not been previously described. Physicians should be aware that congenital bands can cause small bowel obstruction in children and that surgical treatment is required.

Topics: Abdominal Pain; Child, Preschool; Diagnosis, Differential; Foreign Bodies; Humans; Intestinal Obstruction; Jejunal Diseases; Jejunum; Male; Pica

Topics: Abdominal Pain; Bezoars; Child, Preschool; Humans; Ileum; Male; Pica; Polyurethanes; Radiography

Trichobezoars are a rare cause of upper gastrointestinal symptoms and most commonly occur in young females with trichophagia. A case, occurring in a 19 year old woman, complicated by transient pancreatitis and jejunal perforation, is presented.

Topics: Abdominal Pain; Adult; Bezoars; Female; Hair; Humans; Intestinal Perforation; Jejunal Diseases; Pancreatitis; Pica; Stomach

Topics: Abdominal Pain; Child; Child, Preschool; Humans; Male; Pica