pica and Intestinal-Perforation

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 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

Topics: Colon, Sigmoid; Colorectal Surgery; Female; Humans; Intestinal Perforation; Middle Aged; Pica; Radiography, Abdominal; Rectum; 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

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

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

Topics: Female; Humans; Intestinal Perforation; Middle Aged; Peritonitis; Pica; Sigmoid Diseases

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: Adolescent; Foreign Bodies; Humans; Intestinal Perforation; Intestines; Male; Pica

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

Topics: Adult; Female; Humans; Intellectual Disability; Intestinal Perforation; Male; 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

A case of stercoraceous perforation of the bowel in a 31-year-old woman, an habitual paper eater, is reported. Treatment was by evacuation of the faecal mass through the enlarged perforation and direct closure of the perforation without proximal colostomy.

Topics: Adult; Cathartics; Colonic Diseases; Feces; Female; Humans; Intestinal Perforation; Pica