Intestinal obstruction in a mentally retarded patient due to pica

Abstract

A 40-year-old mentally retarded Japanese man was admitted at rehabilitation facility for handicapped persons and found dead in his bed. His neonatal period was complicated by seizures, and he had a medical history of schizophrenia. A postmortem computed tomography scan suggested an intestinal obstruction, but the cause was unknown. To clarify the cause of death, a medicolegal autopsy was carried out. The gastrointestinal tract was found to contain copious amounts of cloth pieces. A diagnosis of intestinal obstruction secondary to pica of clothes was made. Despite still being an essentially neglect condition; mental retardation is cause to significant burden to the patient, his relatives and caregivers and the whole society. Moreover, people with mental retardation may be at increased risk for potentially self-injury due to ingestion of non-eating substance or incongruent intake of eating substances, which may on turn lead to severe or even life-threatening medical and surgical complications as herein reported. Specific attention also to pica in mentally-retarded patients with sudden, severe, gastrointestinal events, should therefore be placed in order to prevent potential death or otherwise severe chronic consequences, ideally aiming at enhancing the early recognition and multi-disciplinary management of those psychological stressors or triggers potentially responsible for pica too.

Introducing a New Nursing Intervention Developed for Self-Injury Behaviour in Children with Intellectual Disabilities

“…10 A diagnosis of ID may be lead to an increased risk for potentially developing SIB, which may, in turn, lead to severe or even life-threatening medical and surgical complications. 11 In sum, in treating this child's SIB, this new intervention can be said to be successful in this case in conjunction with a holistic primary nursing approach involving nurses, teachers and parents. This finding highlights the need for new initiatives that enable nurses to provide on-site diagnosis and care in school health nursing contexts, not just with hospitals, but also in health promotion programmes and early interventions.…”

Pica: Dental findings of an uncommon eating disorder in two clinical case reports

“…This goes against what has been described in the literature that many patients would find it difficult to speak openly about this habit for health teams. [2,[5][6][7] The personality disorder may play a role in this pattern.…”

“…The reluctance of patients to recognize and report the practice to the health team makes it a likely underdiagnosed and underreported condition. [5][6][7] The practice of pica is often observed in children, pregnant women, and individuals with mental disabilities. [8][9][10][11] 25-33% of children and youth have the nonfood substances intake habit, but as they develop, they usually leave the practice, not persisting with this during adulthood.…”

Endoscopic retrieval of gastric trichophytobezoar

“…Most trichophytobezoars and trichobezoars are caused by trichophagia, which is a manifestation of pica. [ 14 ] Trichophagia is usually accompanied by trichotillomania, a rare psychiatric disorder characterized by the impulse to pull out one's own hair. The causes of trichotillomania and trichophagia are not completely understood.…”