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 Table of Contents 
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
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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 2021 Sep 24];5:499-500. Available from: https://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.

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Conflicts of interest

There are no conflicts of interest.

  References Top

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
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  
Lacey EP. Broadening the perspective of Pica: Literature review. Public Health Rep 1990;105:29-35.  Back to cited text no. 3


  [Figure 1], [Figure 2], [Figure 3]


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