Acute abdominal pain revealing lithophagia

Acute abdominal pain revealing lithophagia

Zakaria Toufga^1,&, 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

Introduction    

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     

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     

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     

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

Competing interests     

The authors declare no competing interest.

Authors' contributions     

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

Figures     

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     

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