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Case report

Acute abdominal pain revealing lithophagia

Acute abdominal pain revealing lithophagia

Zakaria Toufga1,&, Hassan Doulhousne1, Abdelghani El Fikri1

 

1Department of Radiology, Guelmim Military Hospital, Guelmim, Morocco

 

 

&Corresponding author
Zakaria Toufga, Department of Radiology, Guelmim Military Hospital, Guelmim, Morocco

 

 

Abstract

We report the case of a 24-year-old patient with cognitive impairment admitted to the emergency department for acute abdominal pain and for whom the imaging revealed several digestive stones, in the absence of complications the treatment was monitored with lubricants with the elimination of all stones and good clinical evolution. This psychiatric disorder is rare and known as lithophagia and requires psychiatric monitoring and follow-up.

 

 

Introduction    Down

Lithophagia is a psychiatric disorder belonging to the family of PICA; it is a severe form that requires serious monitoring, patients can eat significant amounts of stone and caused a severe occlusive syndrome or even digestive perforations.

 

 

Patient and observation Up    Down

A 24-year-old patient with cognitive impairment who was admitted to the emergency department for acute abdominal pain without fever or material or gas arrest; the clinical examination was unremarkable; a plain abdominal X-ray revealed the presence of several foreign bodies of calcium tone in the colon and rectum (Figure 1), a computed tomography showed the presence of multiple foreign bodies with a density exceeding 2000 HU (Figure 2,Figure 3), in the duodenum, colon and rectum without signs of occlusion or digestive perforation. In the absence of signs of occlusion or perforation, the patient was placed under surveillance with psychiatric follow-up and antipsychotic treatment; he received a rectal evacuation of the stool with lubricants and after 7 days, he eliminated more than 35 stones with a good clinical evolution.

 

 

Discussion Up    Down

Pica is a psychological disorder defined by the ingestion of non-nutrients for a long time; lithophagia is an extremely rare form of Pica that involves ingestion of stone [1], this disease can be revealed by nutritional deficiencies, abdominal pain, vomiting, occlusions or even perforation of the digestive tract [2]; patients require follow-up and psychiatric care, in case of complication, surgical intervention is urgently needed; endoscopic extraction may be indicated with good result especially for these patients who often represent repeated episodes [3]; but the indication of a medical, endoscopic or surgical treatment differs according to the patients, the clinical presentation and the presence or absence of complication.

 

 

Conclusion Up    Down

Lithophagia is a rare form of pica, early diagnosis and psychiatric follow-up is necessary to prevent serious gastrointestinal complications.

 

 

Competing interests Up    Down

The authors declare no competing interest.

 

 

Authors' contributions Up    Down

All the authors have read and agreed to the final manuscript.

 

 

Figures Up    Down

Figure 1: a plain abdominal X-ray revealed the presence of several foreign bodies of calcium tone in the colon and rectum without visualization of hydroaeric levels

Figure 2: axial section of an abdominal CT showing calcium-like foreign bodies in the rectum and sigmoid (density exceeding 2000 HU) with no sign of occlusion or digestive perforation

Figure 3: reconstruction in volume rendering mode showing the stones

 

 

References Up    Down

  1. Rajendra A, Koshy M, Mishra AK, Hansdak SG. Lithophagia: presenting as spurious diarrhea. J Family Med Prim Care. 2016;5(2): 499-500. PubMed | Google Scholar

  2. Somalwar A, Dave KK. Lithophagia: pebbles in and pebbles out. J Assoc Physicians India. 2011;59:170. PubMed | Google Scholar

  3. Shahverdian DE, Mariyappa A, Wisinger D, Ravi J, Verma S, Nadir A. Successful removal of cecal stones by using a colonoscope in an individual with repeated lithophagia. Gastrointest Endosc. 2009 May;69(6):1188-90. PubMed | Google Scholar