pica and Necrosis

Pica is characterized by the persistent eating of non-nutritive substances over some time that is inappropriate for the maturation stage of the individual and is not culturally sanctioned. A 9-year-old boy with Goldenhar syndrome, significant developmental delay and pica, collapsed and died after a short history of diarrhea and vomiting. Death was due to a sigmoid volvulus resulting from filling of the distal colon with feces containing dirt, stones, and rice with evidence of ischemic intestinal necrosis. Lethal complications of pica include intestinal obstruction and perforation with peritonitis and generalized sepsis. Other findings at autopsy may include airway obstruction, heavy metal poisoning, and parasitic infestation. Presenting symptoms and signs of such complications may be subtle or masked given the nature of underlying conditions, and so careful evaluation of the medical histories of individuals with pica may be necessary to provide pertinent details of associated medical and psychiatric conditions.

Topics: Child; Colon, Sigmoid; Developmental Disabilities; Feces; Forensic Pathology; Goldenhar Syndrome; Humans; Intestinal Mucosa; Intestinal Volvulus; Intestine, Large; Male; Necrosis; Pica

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