Subocclusive Syndrome Revealing a Lithophagia-Type PICA in a 5-Year-Old Child: A Case Report
Mahamat Mahamat Saleh *
Pediatric Surgery Department, Hassan II University Hospital, Faculty of Medicine, Pharmacy, and Dentistry, Sidi Mohamed Ben Abdallah University, Fez, Morocco.
Oumar Abakar Mahamed
Department of Epidemiology, Clinical Research and Community Health, Hassan II University Hospital, Faculty of Medicine, Pharmacy and Dentistry, Sidi Mohamed Ben Abdellah University, Fez, Morocco.
Hajar Dardar
Pediatric Surgery Department, Hassan II University Hospital, Faculty of Medicine, Pharmacy, and Dentistry, Sidi Mohamed Ben Abdallah University, Fez, Morocco.
Loula Djama Miguil
Pediatric Surgery Department, Hassan II University Hospital, Faculty of Medicine, Pharmacy, and Dentistry, Sidi Mohamed Ben Abdallah University, Fez, Morocco.
Ahmat Tidjani Mahamat
Pediatric Surgery Department, Hassan II University Hospital, Faculty of Medicine, Pharmacy, and Dentistry, Sidi Mohamed Ben Abdallah University, Fez, Morocco.
Ibrahim Mahamat Ahmat
Pediatric Surgery Department, Amirou Boubacar Diallo University Hospital, Abdou Moumini University, Niamey, Niger.
Amné Ali Sakine
Pediatric Surgery Department, Ibn Sina University Hospital, Faculty of Medicine, Pharmacy and Dental Medicine, Mohammed V University, Rabat, Morocco.
Ibrahim Digo Djaafar
Mother and Child Intensive Care Unit, Hassan II University Hospital, Faculty of Medicine, Pharmacy, and Dental Medicine, Sidi Mohamed Ben Abdallah University, Fez, Morocco.
Moussa Gna Abba
Visceral Surgery Department, National Reference University Hospital, N'Djamena, Chad.
Abdoulaye Affadine Ismail
Department of Epidemiology, Clinical Research and Community Health, Hassan II University Hospital, Faculty of Medicine, Pharmacy and Dentistry, Sidi Mohamed Ben Abdellah University, Fez, Morocco.
Zineb Oudrhiri
Pediatric Surgery Department, Hassan II University Hospital, Faculty of Medicine, Pharmacy, and Dentistry, Sidi Mohamed Ben Abdallah University, Fez, Morocco.
Naoufel Boumahdi
Pediatric Surgery Department, Hassan II University Hospital, Faculty of Medicine, Pharmacy, and Dentistry, Sidi Mohamed Ben Abdallah University, Fez, Morocco.
Othmane Alaoui
Pediatric Surgery Department, Hassan II University Hospital, Faculty of Medicine, Pharmacy, and Dentistry, Sidi Mohamed Ben Abdallah University, Fez, Morocco.
Abdelhalim Mahmoudi
Pediatric Surgery Department, Hassan II University Hospital, Faculty of Medicine, Pharmacy, and Dentistry, Sidi Mohamed Ben Abdallah University, Fez, Morocco.
Khalid Khattala
Pediatric Surgery Department, Hassan II University Hospital, Faculty of Medicine, Pharmacy, and Dentistry, Sidi Mohamed Ben Abdallah University, Fez, Morocco.
Youssef Bouabdallah
Pediatric Surgery Department, Hassan II University Hospital, Faculty of Medicine, Pharmacy, and Dentistry, Sidi Mohamed Ben Abdallah University, Fez, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Background: Pica is defined by the persistent ingestion of non-nutritive substances and may lead to gastrointestinal and haematological complications. Lithophagia, the ingestion of stones, is an uncommon form of pica and is rarely reported as a cause of subocclusive syndrome in children. This case report describes a five-year-old child with lithophagia complicated by colonic accumulation of stones, subocclusive symptoms and severe anaemia.
Case Presentation: A five-year-old female child from the Fez-Meknes region of Morocco presented with a three-day history of failure to pass stools, abdominal pain during attempts at defecation and a two-year history of pica with passage of stones in the stool. She had no previous hospitalisation and no reported family history of behavioural or psychiatric disorders. On examination, she was conscious and clinically stable, with pale conjunctivae and mild abdominal distension. The abdomen was soft but firm in some areas and painful on deep palpation. A plain abdominal X-ray showed multiple calcified opacities throughout the colonic region. Laboratory investigations revealed microcytic anaemia with a haemoglobin level of 5.6 g/dL, thrombocytopenia of 33,000 cells/mm³, a white blood cell count of 21,000 cells/mm³ and a C-reactive protein level of 43 mg/L. The diagnosis was subocclusive syndrome in the context of lithophagia-type pica complicated by severe anaemia. Management included dietary measures, rehydration, analgesia, antibiotic therapy, red blood cell transfusion, oral laxatives and repeated manual rectal evacuation under sedation. After three evacuation procedures, the colon was radiologically cleared and bowel movements resumed normally. The patient was discharged after ten days and referred for child psychiatric follow-up.
Conclusion: Lithophagia should be considered in children presenting with constipation, abdominal symptoms and unusual eating behaviour. Early diagnosis and multidisciplinary management may allow successful conservative treatment and avoid surgical intervention.
Keywords: Subocclusive syndrome, lithophagia, pica, intestinal obstruction, colonic stones, foreign body ingestion, child, anaemia, manual rectal evacuation, case report