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![]() ![]() ![]() The abdominal ultrasound objectified a hyper echogenic epigastrium mass with posterior acoustic cone of shadow. Plain abdominal film objectified hydro-aeric levels. The rate of prothrombin was 70% and the activated cephaline time at 30 s. Sodium was 125 mmol/L, potassium at 1.5 mmol/L. In the biological balance assessment: hemoglobin was at 12 g/dL, hematocrit at 36.5%, plaques at 265,000, white blood cells at 13,000, uremia in 0.5 g/L, creatinine at 6 mg/L, CRP at 1 0mg/L. The rectal bulb was empty in the rectal examination. A farm, mobile and painless enormous mass going from left hypochondria to the epigastrium of approximately 20 cms was palpated. The clinical examination showed an altered general state of the child, well colored conjunctives, her temperature at 37 and her weight at 35 kg. The surgical outcome was good.ġ4-year-old girl, without remarkable pathological history, in whom the symptomatology begun 3 months ago, by an atypical diffuse abdominal pains located at the epigastrium, accompanied with late postprandial food vomiting, no obstacle on the GI track, but weight loss and anorexia. She went out of the hospital at D7 with a request of psychiatric evaluation. The nasogastric probe was removed at D3 and liquid food authorized. The intestinal transit started again at post operative day 1. There was no complication following this surgery. So 53 spikes, a pin and bands of tape recorder cassette ( Figure 4) were extracted. We realized a transverse gastrotomy of 4 cms with the soft and progressive extraction of nails ( Figure 3). During surgery, we have identified a pre-perforative The patient has been resuscitated to correct the hydro electrolytic imbalance during 6 hours preceding the surgical intervention. The diagnosis of peritonitis by gastric perforation was done. In the biological balance assessment: hemoglobin was at 9 g/dl, white blood cells at 13,000, plaques at 200,000, the level of prothrombin at 80%, natrium at 110 mmol/L, potassium at 2 mmol/L, uremia at 0.6 g/L and a creatinine at 0.8 mg/L. An abdominal scan ( Figure 2) showed mild abundance of intra-abdominal effusion and the presence of nails in the stomach suspecting a gastric perforation. Plain abdominal film performed objectified the presence of a heap of nail in the stomach without visualizing a pneumoperitoneum ( Figure 1). The rectal bulb was filled with stools in the rectal examination. Also, we noticed a diffuse abdominal sensibility, as well as tangible mass at the areas of the left hypochondriac. In abdominal palpation we noticed the presence of skin folds indicating a dehydration and malnutrition. During her abdominal examination: we inspected, an abdomen following well breathing pattern and an epigastrium coving. She was stable on the hemodynamic and respiratory exam. Our clinical examination concludes, a patient with a good consciousness, an altered general body state, conjunctives normal colored, she weighted 34 kg, with a body temperature of 37.5˚C. She was referred to us in pediatric surgery for better care. The child received a non-specified traditional treatment that was unsuccessful. She was received for diffuse abdominal pain and anorexia, no obstruction to her GI track, nor vomiting. Symptoms begun 3 weeks before her hospital admission. The informed consents of the children’s parents were obtained.ġ4-year-old female, 3rd of a sibling of 4, followed in psychiatry for mental disorders, admitted for abdominal pain following an ingestion of not digestible foreign bodies. We report three cases of digestive complications in Pica syndrome. Ingestion of non-food substances can be responsible for digestive complications most often requiring surgical management. Patients are treated on a case-by-case basis. The etiology is not well defined and there is no standard treatment for this syndrome. This prevalence would increase with the severity of intellectual disability. Its prevalence ranges from 9.2% to 25.8%, depending on whether Pica’s syndrome is confined to the consumption of non-food products, or whether it covers ingestion of food and non-food substances. Pica syndrome is an eating disorder mainly observed in people with severe or profound mental deficiency or in those with autism. ![]()
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