Journal of Family Medicine and Primary Care

: 2016  |  Volume : 5  |  Issue : 2  |  Page : 499--500

Lithophagia: Presenting as spurious diarrhea

Akhil Rajendra, Maria Koshy, Ajay Kumar Mishra, Samuel George Hansdak 
 Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India

Correspondence Address:
Akhil Rajendra
Department of Medicine, Christian Medical College, Vellore - 632 002, Tamil Nadu

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 2021 May 13 ];5:499-500
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Full Text

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}{Figure 2}

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}

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.

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3Lacey EP. Broadening the perspective of Pica: Literature review. Public Health Rep 1990;105:29-35.