pica and Intestinal-Obstruction

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

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

Up to 25% of institutionalized patients with cognitive deficiencies display pica-like behavior, with an estimated annual incidence of small bowel obstruction of 2%. We present a case based on the forensic autopsy of a 41-year-old woman who died as a result of a missed diagnosis of small bowel obstruction after ingesting a foreign body. The case underlines the importance of precaution when treating patients with cognitive deficiency and/or language deficits and gastrointestinal symptoms. In such cases, it is important to employ a liberal threshold for radiological investigations and, if possible, obtain a medical history from a person close to the patient.

Topics: Adult; Autopsy; Female; Foreign Bodies; Humans; Intestinal Obstruction; Pica

Geophagy is widespread among women from Sub-Saharan Africa, South America and the Caribbean and may persist in western countries. This practice may be associated with adverse effects such as anaemia, constipation or intestinal occlusion. We aimed to determine the prevalence of geophagy and the level of knowledge about its health effects among healthy adults originating from these countries and attending a travel medicine and international vaccination consultation in France. Among 101 travellers enrolled in the study, 83 (82.1%) were born in Sub-Saharan Africa and 13 (12.8%) in South America or the Caribbean. The mean duration of residence in France was 15.6 ± 10.4 years. Previous or current geophagy was present in 42 travellers [previous geophagy in 31 (30.7%) and current consumption in 11 (10.9%)]; 38 (90.5%) were women. The rate of awareness of harmful effects of geophagy as the risk of iron-deficient anaemia (18.8%) and soil-transmitted intestinal parasitic infections (11.9%) was low overall. Women with previous or current geophagy more often had history of iron therapy compared to those who never consumed, both during pregnancy (50.0 versus 14.3%; p = 0.0009) and outside pregnancy (47.4 versus 2.8%; p < 0.0001). Despite a long period of residence in France, geophagy was still a current practice among 10.9% of Sub-Saharan, South American and Caribbean travellers, who are poorly informed of its harmful effects. Therefore, specific information tailored to Sub-Saharan, South American and Caribbean about the risks of geophagy should be implemented in western countries.Level of evidence Level V, descriptive cross-sectional survey.

Topics: Adult; Africa South of the Sahara; Anemia, Iron-Deficiency; Caribbean Region; Constipation; Emigrants and Immigrants; Female; France; Health Knowledge, Attitudes, Practice; Heavy Metal Poisoning; Humans; Intestinal Diseases, Parasitic; Intestinal Obstruction; Male; Middle Aged; Pica; Prevalence; Soil; South America

In this report, a pediatric case of bowel obstruction with sepsis complicated by methamphetamine toxicity is described. The decedent, an eleven-year-old female with a clinical history of pica, was found unresponsive in her home and pronounced dead following unsuccessful resuscitative efforts. Radiologic imaging showed multiple radio-opaque foreign objects in the stomach and bowel. Autopsy revealed a green leafy substance, coins and other metallic items, folded paper, and plastic in her stomach and bowels. Postmortem iliac blood and urine tested positive for amphetamine and methamphetamine. While the decedent's medical history and autopsy findings provided evidence consistent with bowel obstruction with sepsis due to the ingestion of foreign materials, the high methamphetamine concentration was suggestive of concurrent methamphetamine toxicity. Unique complications associated with this case include the phenomenon that methamphetamine toxicity and bowel obstruction can present similarly in children and the reported opinion that accidental drug ingestion is uncommon in children over the age of five. This case emphasizes that the age range for suspected accidental drug ingestion should be expanded for those with pica, as these patients, despite being older, may not be able to differentiate between what they should and should not ingest. Furthermore, when treating a pediatric patient with pica that appears to present with bowel obstruction, unintentional drug ingestion should also be considered, particularly if there is a suspicion that the child lives in a household where drugs are abused, given the prospect that drug toxicity can present similarly.

Topics: Amphetamine; Central Nervous System Stimulants; Child; Colon, Sigmoid; Drug Overdose; Female; Foreign Bodies; Humans; Intestinal Obstruction; Methamphetamine; Pica; Sepsis; Stomach

A young adult black female, known to be a prostitute and suspected of smuggling narcotics, was found dead in her apartment in a state of early decomposition. Oval-shaped gray-white masses of exogenous origin protruded from the anus. The autopsy showed dilatation of the folds of the large intestine, which were almost completely filled with these oval-shaped gray-white masses of foreign material. The uterus was enlarged with multiple large leiomyomas. Toxicological tests of blood and the foreign material revealed no toxicologically relevant substances. Kaolin was detected in a sample of the foreign material from the large intestine. The immediate cause of death was intestinal obstruction due to the formation of a kaolin bezoar with simultaneous compression of the large intestine by the enlarged myomatous uterus. Subsequent revelation of a habit the deceased had brought from her native country led to the conclusion that this exotic custom was responsible for her death.

Topics: Bezoars; Fatal Outcome; Female; Foreign Bodies; Humans; Intestinal Obstruction; Kaolin; Leiomyomatosis; Nigeria; Pica; Sex Workers; Uterine Neoplasms; Young Adult

We describe an 8-year-old white boy with a history of fetal alcohol syndrome and pica, who was found dead on the floor by his mother. The child died from massive intestinal dilatation causing asphyxia. We discuss the potential pathogenetic mechanisms of intestinal dilation in patients with fetal alcohol syndrome.

Topics: Asphyxia; Child; Fetal Alcohol Spectrum Disorders; Foreign Bodies; Humans; Intestinal Obstruction; Male; Pica

Topics: Bezoars; Child, Preschool; Diarrhea; Female; Gastroscopy; Humans; Intestinal Obstruction; Intestines; Pica; Stomach; Syndrome; Vomiting

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

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

The majority of ingested foreign bodies pass of their own accord without causing any adverse impact on the patient, while others present a greater management dilemma. We present a case of a 36-year-old man admitted to the hospital with a 10-day history of colicky abdominal pain following voluntary ingestion of multiple pairs of vinyl gloves. The plain-film abdominal X-ray confirmed small bowel obstruction and gastric bezoar. After failed conservative management he opted for endoscopic retrieval. Following exposure to stomach acid the gloves had lost their structural integrity becoming hard, sharp and brittle. As a result endoscopic removal was abandoned due to the risk of traumatic injury to the oesophagus. A midline laparotomy was performed and the gloves were retrieved via enterotomy. While many foreign bodies are suitable for endoscopic extraction this case demonstrates that the retrieval of vinyl gloves is unlikely to be successful due to significant chemical change.

Topics: Adult; Bezoars; Conversion to Open Surgery; Foreign Bodies; Gastroscopy; Humans; Ileal Diseases; Intestinal Obstruction; Intestinal Perforation; Male; Pica; Treatment Outcome

Vinyl gloves when ingested will harden and develop sharp edges producing gastric bezoars; bowel obstruction; and, ultimately, perforation. We report 4 children with complications secondary to vinyl glove ingestion who required surgical intervention.. A 3-year-old boy, a 13-year-old adolescent girl with Down syndrome, a 14-year-old adolescent girl, and a 15-year-old adolescent boy presented with bowel obstruction secondary to a bezoar caused by a vinyl glove. The adolescent girl with Down syndrome presented again at age 17 years with a large vinyl glove gastric bezoar. Three of the children had mental retardation, and 1 was a victim of child abuse. Three had laparoscopic-assisted removal of the vinyl glove bezoar, and 1 had laparotomy.. The 4 children recovered uneventfully. Two of the patients had unsuspected intestinal perforation. The caretakers denied awareness of the vinyl glove ingestion.. Vinyl glove ingestion can cause intestinal obstruction and perforation. Vinyl gloves should be removed from the immediate proximity of mentally retarded patients or patients with pica. Most of the time, the finding of vinyl gloves as etiology of the obstruction or perforation is incidental. If the event is known or witnessed, prompt surgical intervention is generally recommended.

Topics: Adolescent; Bezoars; Child, Preschool; Female; Gloves, Protective; Humans; Intellectual Disability; Intestinal Obstruction; Intestinal Perforation; Intestine, Small; Laparoscopy; Laparotomy; Male; Pica; Stomach

This case concerns a 10-year-old boy with a history of behavioral abnormality that arrived at our surgical emergency room with acute abdominal discomfort. The boy had acute colitis-like clinical symptoms resulting from ingested and retained foreign bodies in the colon. These foreign bodies (gravel and stones) had accumulated in the entire colon over a period of 1 year. Attempts to dislodge the foreign bodies from the rectum by mechanical means failed; therefore the possibility of surgical intervention was considered in view of the worsening colitis. However, the problem was finally resolved by repeated basketting by colonoscopy, antibiotics and later laxatives. The case is noteworthy because of the extent of the condition, difficulty of the decision-making, and the relative success of watchful conservative measures.

Topics: Child; Colitis; Foreign Bodies; Humans; Intestinal Obstruction; Male; Pica

There are many ways how children with mental illness have actually tried to hurt themselves. Suicidal thinking or attempts always indicate that professional help is needed (2). Every object which can be potential dangerous should be removed but this is very difficult to do. Some of children with these symptoms had Pica diseases. Pica is a medical disorder characterized by an appetite for substances largely non-nutritive (e.g. metal, coal, soil, feces, paper, soap, gum, etc.) or an abnormal appetite for some things that may be considered foods.. The patient swallow sponge from a pillow over a long period of time and she came into our hospital with abdominal pain. She was 16 years old and had abdominal distension, vomiting, abdominal cramping and failure to pass gas or stool. Immediately we suspected mechanical blockade of the intestine. Diagnosis was clinically confirmed by X-rays of the abdomen and with ultrasound.. The operative treatment was indicated and we found the proximal bowel distended and the distal segment collapsed. The part of bowel necrosis was removed and anastomosis was done.. When patients are determined to attempt suicide or have Pica disorder it is very difficult to prevent.

Topics: Adolescent; Female; Foreign Bodies; Humans; Intestinal Obstruction; Pica; Suicide, Attempted

Pica as an eating disorder is uncommonly associated with surgical complications. Paper as the consumed substance has been previously reported twice in the literature.. We present a case of bowel obstruction and ischemia secondary to paper pica. The pathophysiology, histology, and characteristics of this entity are presented, and emphasis is placed on clinical suspicion in patients with psychiatric history.

Topics: Colectomy; Colitis, Ischemic; Colon; Female; Humans; Intestinal Obstruction; Ischemia; Middle Aged; Necrosis; Paper; Pica

A bezoar is an accumulation of indigestible exogenous matter in the stomach and intestine. A myriad of ingested substances have been found impacted in the digestive tract. Bezoars are uncommon causes of intestinal obtruction during childhood. Lithobezoar, an accumulation of ingested stones within the alimentary tract, is an extremely rare clinical entity. We report one such case in a 9-year-old boy with a history of pica and long-term constipation resulting in intestinal obstruction secondary to a colonic lithobezoar. Only two such cases have been reported previously.

Topics: Bezoars; Child; Colonic Diseases; Enema; Fecal Impaction; Humans; Intestinal Obstruction; Male; Pica

Bezoars and foreign bodies are frequently encountered in children with psychiatric disorders. Eating disorder (called pica) occurs predominantly in some high-risk patients such as psychiatric and mentally disabled children. Small-bowel obstruction is an uncommon complication of ingested foreign body because the foreign body is able to cross the whole small intestine and be excreted in the feces.We present the case history of an autistic adolescent who was operated on because of bowel obstruction due to an unusual foreign body.

Topics: Adolescent; Autistic Disorder; Bezoars; Cardia; Cellulitis; Diagnosis, Differential; Duodenum; Emergencies; Enterostomy; Foreign Bodies; Gastroscopy; Humans; Ileal Diseases; Intestinal Obstruction; Laparoscopy; Laparotomy; Male; Pica; Plant Structures; Umbilicus

The cause of intestinal obstruction in children can occasionally be obscure although history and examination usually directs the clinician to the correct diagnosis. Pica, the ingestion of non-nutrient material, however can be surreptitious and escape detection. A case report is presented of a 9-year-old child with an extensive and complicated surgical history. Following lengthy investigation and progression of sub-acute to acute intestinal obstruction over a long period, the cause was finally found to be due to persistent ingestion of Blu-Tack -- a common household putty-like adhesive.

Topics: Adhesives; Child; Diagnosis, Differential; Female; Humans; Intestinal Obstruction; Pica

Topics: Enema; Female; Humans; Infant; Intestinal Obstruction; Intestine, Small; Pica; Radiography; Silicon Dioxide; Treatment Outcome; Water

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

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: Adult; Bezoars; Female; Humans; Interior Design and Furnishings; Intestinal Obstruction; Pica; Rubber

Topics: Adolescent; Humans; Intestinal Obstruction; Male; Mental Disorders; Pica

Necrotizing enterocolitis (NEC) now is managed frequently successfully without surgical intervention. NEC may result in strictures, which present after the acute inflammatory process has resolved. Strictures usually present as obstruction in the first year or two of life. A case report is presented of an 11-year-old child who had symptoms from a previously undiagnosed NEC stricture as a result of pica when coins obstructed the stricture. As treatment of NEC continues to improve, more and later complications of this disease can be expected. J Pediatr Surg 36:1853-1854.

Topics: Child; Colectomy; Colon; Enterocolitis, Necrotizing; Female; Foreign Bodies; Humans; Intestinal Obstruction; Pica

Two primary school age children having severe pica for sand, presented with severe constipation caused by sandy faecal impaction, simulating intestinal obstruction. Digital disimpaction and enema relieved the symptoms.

Topics: Child; Child, Preschool; Constipation; Diagnosis, Differential; Enema; Fecal Impaction; Female; Humans; Intestinal Obstruction; Pica

Topics: Adult; Aluminum Silicates; Clay; Colonic Diseases; Female; Humans; Intestinal Obstruction; Intestinal Perforation; Pica; Pregnancy; Pregnancy Complications

Topics: Anemia, Hypochromic; Bezoars; Child, Preschool; Humans; Intestinal Obstruction; Male; Pica

Topics: Child; Female; Humans; Intestinal Obstruction; Pica

Eleven Aboriginal patients from the Northern Territory, in whom radiological examination of the abdomen demonstrated opaque masses of clay in the colon are described. This was due to the eating of white clay which is found only in streams, springs and billabongs of the coastal areas of the Territory. The habit does not appear to be a perversion of appetite, nor is it related to anaemia or pregnancy. The clay is eaten mainly for medicinal purposes or to allay hunger. The results are not always beneficial, since clay caused complications (including obstruction and perforation of the colon) in five of our 11 patients.

Topics: Adolescent; Adult; Australia; Child, Preschool; Colonic Diseases; Female; Humans; Intestinal Obstruction; Intestinal Perforation; Male; Medicine, Traditional; Middle Aged; Native Hawaiian or Other Pacific Islander; Pica; Radiography

Topics: Child; Humans; Intestinal Obstruction; Intestine, Large; Male; Pica

The significance of pica and geophagia as a public health problem is well known. The objective radiographic diagnosis of geophagia depends on the abnormal opacification of the bowel as an immediate manifestitation of the condition. The chance of detectability of geophagia is highest in the colon and can be improved by using low penetration films, particularly for smaller amounts of ingested clay. Other radiologic changes frequently associated with the prolonged practice of geophagic are an atonic pattern of the colon, secondary radiographic changes due to iron-deficiency anemia and bone-age retardation. The occurrences of intestinal obstruction due to pica in the presence of preexisting bowel stricture is demonstrated.

Topics: Anemia, Hypochromic; Bone Diseases, Developmental; Calculi; Child; Colon; Digestive System; Evaluation Studies as Topic; Humans; Intestinal Diseases; Intestinal Obstruction; Iran; Pica; Radiography; Soil

Topics: Abruptio Placentae; Adult; Diagnosis, Differential; Enema; Female; Humans; Intestinal Obstruction; Intestine, Large; Male; Pica; Pregnancy; Time Factors; Twins; Uterus

Topics: Adult; Bezoars; Female; Humans; Ileum; Intestinal Obstruction; Paper; Pica; Radiography

Topics: Bezoars; Digestive System; Feeding and Eating Disorders; Gastrointestinal Diseases; Humans; Intestinal Obstruction; Pica; Pregnancy; Pregnancy Complications