Teaching Case

An eight-year-old child presented to the emergency department with lower abdominal pain. On further questioning the patient reported a history of similar on and off pain and constipation for more than a year. Abdomen felt slightly firm on palpation. The patient's blood testing was unremarkable.

An erect radiography of the abdomen was performed which showed extensive radio-opacity in both the large and small bowel loops. There was no history of contrast study in the past. On further questioning the patient reported a history of consumption of small sand and rock particles at home. The patient was treated conservatively with rectal enema. Multiple stones were extracted. The patient's pain subsided and he was able to evacuate normally on follow up.

Geophagia is defined as deliberate consumption of soil, earth or clay. It has been considered as due to a psychiatric illness or secondary to poverty/famine [1]. Geophagia has been classified as a form of pica. Pica is a psychological condition characterized by persistent eating of substances such as dirt or paint that have no nutritional value. It is most commonly seen in children. It can also be seen in pregnant patients secondary to iron deficiency [2]. Patients fail to divulge this habit to doctors due to social stigma. Patients present with symptoms suggestive of intestinal obstruction. Complications of the condition include intestinal obstruction, peritonitis, perforation, parasitic infestation, and electrolyte imbalance [1, 3, 4]. Diagnosis is mainly dependent on good history taking. Confirmation of diagnosis can be made on abdominal radiograph which shows radiodensity within the bowel loops with no history of a contrast bowel study. Various treatment options include conservative management, manual evacuation or surgical resection based on the patient's condition and complications [1, 5].

Take home message: Geophagia is a rare but important cause of intestinal obstruction which can be treated successfully by conservative means when diagnosed early.