An 8-year-old girl with an abdominal mass

Yogev, Yariv; Katz, Miriam; Phillip, Moshe

doi:10.1007/s004310050593

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“…[6]. Usually, radiologic tests can provide accurate diagnosis preoperatively; however, in our case radiologic examination failed to set the diagnosis [7].The elimination of symptoms and signs of pica in our patient after IDA treatment emphasizes the strong relation between pica and IDA, and more specifically confirms the causative role of IDA in pica development [8,9]. References 1.…”

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Pica: An Uncommon Cause of Acute Abdominal Pain in Children

et al. 2011

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Sir,We read with considerable interest the excellent review article by Yadav and Chandra [1], which refers to the effects of iron deficiency on tissues, organs and systems. As authors mention, pica represents one of the well-defined clinical manifestations of iron deficiency anemia (IDA). Their relation is widely recognized and most studies suggest that pica is a reversible manifestation of iron deficiency state [1,2]. We would like to enhance the knowledge of pica by presenting a relative rare case report.A 14-year-old girl was admitted to our department suffering from acute abdominal pain, mimicking acute appendicitis. Laboratory tests showed polymorphonuclear leucocytosis and anemia (Hb 7.4 g/dl). The other erythrocyte markers were also indicative of iron deficiency anemia and serum iron level was low (15 μg/dl). Imaging tests of the abdomen were unremarkable.Based on her clinical presentation, the patient was transferred to the operating room. Through McBurney incision, the right lower quadrant of the abdomen was accessed and the appendix was found with no signs of inflammation. Ovaries and fallopian tubes were unremarkable. Exploration of the ileum revealed the presence of multiple, soft and pliable masses into its lumen. With kind manipulation, these masses easily passed through the ileocecal valve to the cecum. The diagnosis of bezoar was suspected and the operation was completed with appendicectomy.A thorough past medical history, obtained postoperatively, revealed patient's abnormal eating habit of consuming clay, ice and wall dust. This finding in association with IDA set the diagnosis of pica. Post-operative course was uneventful and the patient was discharged from the hospital receiving ferrum supplementation therapy. Six months after the operation, the levels of Hb and serum iron were normalized and the patient did not experience any pica symptoms.Pica has been observed in men and women of all ages and ethnicity. Interestingly, it represents a quite common manifestation of IDA, occurring in up to 58% of these patients [2,3]. Patients with pica may present with a variety of clinical manifestations, associated with the specific nature of the ingested substances and the subsequent medical consequences [4,5].Though acute abdomen due to pica is not uncommon in mentally-disabled patients, its incidence in mentally-healthy individuals, like our patient, is quite rare. [6]. Usually, radiologic tests can provide accurate diagnosis preoperatively; however, in our case radiologic examination failed to set the diagnosis [7].The elimination of symptoms and signs of pica in our patient after IDA treatment emphasizes the strong relation between pica and IDA, and more specifically confirms the causative role of IDA in pica development [8,9]. References 1. Yadav D, Chandra J. Iron deficiency: beyond anemia. Indian J Pediatr. 2011;78:65-72. 2. Mark AM. "Tomatophagia" and iron-deficiency anemia. NEJM.

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confidence: 59%

“…[6]. Usually, radiologic tests can provide accurate diagnosis preoperatively; however, in our case radiologic examination failed to set the diagnosis [7].…”

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confidence: 90%