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Pediatric Oncall Journal

Intractable Constipation and Severe Abdominal Pain Due To Compulsive Geophagia in a Child from a Developing Country 01/09/2014 00:00:00

Intractable Constipation and Severe Abdominal Pain Due To Compulsive Geophagia in a Child from a Developing Country

Emmanuel Onyekwelu.
Department of Pediatrics, Royal Victoria Teaching Hospital, The Gambia West Africa.

Emmanuel Onyekwelu, Department of Pediatrics, Royal Victoria Teaching Hospital, Independence Drive P.O BOX 1515, Banjul, The Gambia ,West Africa.
Geophagia is a form of pica that implies ingestion of soil. There appears to be few reported cases of intestinal obstruction following geophagia in children living in the developing countries. A five year old boy presented to the emergency department with a week's history of severe abdominal pains and constipation, associated with geophagia and helminthiasis in the absence of individual, familial psychopathology, or chronic haemopathy.
Geophagia, the deliberate ingestion of sand is a complex eating behaviour with enigmatic aetiology related to multiple psychological or medical defects. It is thought to be less age independent and commoner in girls. No social class is exempted. (1) Complications could include constipation, cramping pain, perforation from sharp objects like rocks or gravel contamination (2) and infection from soil dwelling parasites (3,4). Other complications are variable depending on the characteristics of the earthy substances. Geophagia has been reported by several authors. It has been known to be associated with iron deficiency anaemia, helminthiasis and plumbism in a cause and effect vicious cycle (5). However cases of profound compulsive geophagia with mechanical large and small bowel obstructions are not common in the medical literature of the developing countries.
Case Report
A five year old boy was brought to the Paediatric emergency department by his mother with a week's history of intense abdominal pain and obstinate intractable constipation. He has been ingesting sand and earthy substances since early childhood despite attempts to dissuade him from this practice. He passed worms in his stools on several occasions. He was never transfused before, there is no history of haemopathy and there were no established individual or familial psychopathology. He was asthenic, pale, anicteric, with some facial puffiness but no pedal oedema, there were no significant peripheral lymphadenopathy, digital clubbing or koilonychia. The abdomen was full, firm and vaguely tender with areas of indentation due to scrabulous faecal material. There were no visceromegaly. The percussion notes were uniformly dull. Digital anorectal examination revealed some faecal material with a gritty texture due to its sandy contents, this was suggested by a plain x-ray which revealed a ground glass opacification of the intestinal luminal contents especially the large bowels and evaluated further at transabdominal ultrasonic echography which demonstrated patchy echogenicity. There were no sand bronchograms. The haemoglobin concentration, the packed cell volume, and the mean cell corpuscular haemoglobin concentration and the mean cell haemoglobin were 7.5g/dl, 22%, 27% and 21g/dl respectively. The total and differential white cell counts were normal. The urea, creatinine and electrolytes were normal. He was managed successfully with a lukewarm saline washout enema over several cycles which enabled him to pass a copious amount of sandy faecal material. Intravenous crystalloids were used for circulatory support. He received haematinics and antihelminthics on discharge.
One in every 6th child indulges in geophagy; it is thought not to be common among adults in the absence of psychopathology.(6) Geophagia is a symptom of historical and evolutionary interest. Geophagia was considered a form of paleo medicine, paleo nutrition. Independent experimental studies established that primates ate earth containing clay material to ameliorate diarrhoeal diseases and other digestive ailments and for other health reasons. Lower down the phylum, parrots were noted to eat sand in order to cope with natural defensive toxins produced by plants against seedeaters, because the soil is thought to bind to the noxious quinines and tannins found in the seed coating thereby rendering them harmless. Anecdotally geophagia was regarded a symptom of psychopathology, however historical notes intimates that it was resorted to in times of extreme hardship and famine. The soil is relatively rich in iron, calcium, potassium and magnesium and zinc. Red soil from termite mounds, sometimes eaten as a traditional stomach remedies in some settings were found to be rich in kaolinite, which is an ingredient used in commercial diarrhoeal preparations.(7) Anecdotal evidence intimates that geophagia may be an innate compensatory mechanism for micronutrient deficiency given that this phenomenon is commoner in children with micronutrient deficiency and the soil is relatively rich in these micronutrients. However multicentric studies in Asia and Africa have suggested that whereas calciferous geophagic materials may supplement for calcium, geophagia could potentially cause iron and zinc deficiency. (8).

Direct attributable morbidity and mortality of geophagia is related to gastrointestinal tract endoscopies for the removal of sand foreign bodies, laparoscopy and laparotomies for perforations.(2) This case was managed conservatively; however this may not be achievable in all cases.
Compliance with Ethical Standards
Funding None
Conflict of Interest None
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Cite this article as:
Onyekwelu E. Intractable Constipation and Severe Abdominal Pain due to Compulsive Geophagia in a Child from a Developing Country. Pediatr Oncall J. 2008;5: 145.
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