Sandy faecal impaction caused by severe pica

Area of Science:

• Pediatrics
• Gastroenterology
• Psychology

Background:

• Pica, the persistent eating of non-food substances, can manifest in various forms, including geophagia (eating earth or soil-like substances).
• Severe cases of pica, particularly in children, can lead to significant gastrointestinal complications.
• Sand ingestion, a form of geophagia, poses a risk of fecal impaction and obstructive symptoms.

Observation:

• Two primary school-aged children presented with severe constipation.
• Clinical examination revealed fecal impaction composed of sand, mimicking symptoms of intestinal obstruction.
• The children exhibited a history of severe pica specifically for sand.

Findings:

• The sandy fecal impaction was the direct cause of the severe constipation and obstructive symptoms.
• Manual disimpaction (digital disimpaction) and rectal enemas were effective in relieving the impaction.
• The intervention successfully resolved the presenting symptoms in both children.

Implications:

• Highlights the critical need for recognizing pica as a potential cause of severe constipation and fecal impaction in pediatric patients.
• Emphasizes the importance of prompt gastrointestinal assessment and intervention for suspected fecal impaction, even when symptoms simulate obstruction.
• Suggests that early diagnosis and management of sand pica can prevent serious complications like intestinal obstruction and reduce the need for more invasive procedures.