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LETTER TO EDITOR
Year : 2016  |  Volume : 5  |  Issue : 2  |  Page : 499-500  

Lithophagia: Presenting as spurious diarrhea


Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India

Date of Web Publication18-Oct-2016

Correspondence Address:
Akhil Rajendra
Department of Medicine, Christian Medical College, Vellore - 632 002, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2249-4863.192328

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How to cite this article:
Rajendra A, Koshy M, Mishra AK, Hansdak SG. Lithophagia: Presenting as spurious diarrhea. J Family Med Prim Care 2016;5:499-500

How to cite this URL:
Rajendra A, Koshy M, Mishra AK, Hansdak SG. Lithophagia: Presenting as spurious diarrhea. J Family Med Prim Care [serial online] 2016 [cited 2019 May 23];5:499-500. Available from: http://www.jfmpc.com/text.asp?2016/5/2/499/192328



Dear Editor,

We are presenting to you a 42-year-old female who presented with multiple episodes of small volume, mucoid diarrhea for 5 days, and mild generalized abdominal pain for 1 day to our emergency department. She had developed psychotic symptoms following the recent death of her sibling. She was living alone in an old age home. Clinical examination revealed a dehydrated, thinly built woman with a depressed sensorium, and louse infestation. Her abdomen was soft, minimally tender with sluggish bowel sounds. Imaging of her abdomen showed radioopaque particles in the entire large bowel with a densely packed rectum [Figure 1]. On per rectal examination, numerous small stones were recovered [Figure 2]. On retaking the history, it was found that she had a habit of consuming pebbles from childhood. On psychiatric evaluation, the diagnosis of paranoid schizophrenia was made and her lithophagia was attributed to the same.
Figure 1: Radiograph of abdomen showing radioopaque material densely packed in the rectum, descending colon and transverse colon

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Figure 2: Stones recovered from the rectum after digital rectal disimpaction

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Pica is a disorder characterized by persistent eating of nonnutritive substances, for at least 1 month, at an age for which it is developmentally inappropriate. It can have a clinically benign course or can be life-threatening.[1] It has commonly been associated with iron deficiency, zinc deficiency, developmental delay, mental retardation, and family history of Pica.[2] Common substances consumed include clay, matches, stones, hair, and feces.[3] Manifestations of toxicity, secondary infection, gastrointestinal complications, or dental complications usually cause the patient to seek medical intervention.[3]

Our patient was managed conservatively with adequate hydration and serial rectal evacuation aided by stool softeners. She was started on antipsychotic therapy and had a good clinical response. At discharge, repeat radiograph revealed a significant reduction of stone burden [Figure 3].
Figure 3: Radiograph of abdomen after numerous digital rectal disimpaction

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We bring your attention to this case because of the rarity of such a presentation and nonavailability of literature to suggest possible management for such a case. There will always be a dilemma whether such a patient needs to undergo surgical management or be dealt with a wait and watch approach. In our case, we successfully managed the patient conservatively which resulted in the near completion evacuation of the rectum.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Haoui R, Gautie L, Puisset F. Pica: A descriptive study of patients in a speciality medical center. Encephale 2003;29:415-24.  Back to cited text no. 1
[PUBMED]    
2.
Chakraborty S, Sanyal D, Bhattacharyya R. A unique case of Pica of adult onset with interesting psychosexual aspects. Indian J Psychol Med 2011;33:89-91.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Lacey EP. Broadening the perspective of Pica: Literature review. Public Health Rep 1990;105:29-35.  Back to cited text no. 3
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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