Acute abdominal pain revealing lithophagia
Zakaria Toufga, Hassan Doulhousne, Abdelghani El Fikri
Received: 17 Nov 2019 - Accepted: 17 Nov 2019 - Published: 21 Nov 2019
Keywords: Lithophagia, PICA, abdominal pain
©Zakaria Toufga et al. PAMJ - Clinical Medicine (ISSN: 2707-2797). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cite this article: Zakaria Toufga et al. Acute abdominal pain revealing lithophagia. PAMJ - Clinical Medicine. 2019;1:21. [doi: 10.11604/pamj-cm.2019.1.21.21005]
Available online at: https://www.clinical-medicine.panafrican-med-journal.com/content/article/1/21/full
Acute abdominal pain revealing lithophagia
Zakaria Toufga1,&, Hassan Doulhousne1, Abdelghani El Fikri1
1Department of Radiology, Guelmim Military Hospital, Guelmim, Morocco
Zakaria Toufga, Department of Radiology, Guelmim Military Hospital, Guelmim, Morocco
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.
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.
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.
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 , this disease can be revealed by nutritional deficiencies, abdominal pain, vomiting, occlusions or even perforation of the digestive tract ; 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 ; 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.
Lithophagia is a rare form of pica, early diagnosis and psychiatric follow-up is necessary to prevent serious gastrointestinal complications.
The authors declare no competing interest.
All the authors have read and agreed to the final manuscript.
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
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