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Pica in the mentally handicapped: a 15-year surgical perspective
1Department of Surgery, Orillia Soldiers Memorial Hospital, Ont.
Objective:
To review the general surgical management of mentally handicapped persons with pica.
Design:
A study of hospital records and a review of the current literature.
Setting:
A community hospital.
Patients:
Thirty-five patients from a large institution for the mentally handicapped were treated for well-documented pica on 56 occasions at the Orillia Soldiers Memorial Hospital between 1976 and 1991.
Interventions:
Endoscopy and laparotomy for the removal of foreign bodies or to close perforations.
Results:
Fourteen (25%) cases of pica were managed by observation only, but 42 (75%) cases required surgical intervention. There were 34 laparotomies. The complication rate was 30% and the death rate 11%.
Conclusions:
Pica is a serious health risk for mentally handicapped patients. Diagnosis and postoperative care can be difficult. Pica should be suspected in mentally handicapped patients with gastrointestinal symptoms.