Surgical complications of pica: report of a case of intestinal obstruction and a review of the literature.

The authors describe a patient with chronic renal failure who developed intestinal obstruction from talcum powder pica. A literature review found 43 previously reported cases of surgical complications caused by various forms of pica. Most occurred in women, blacks, aborigines, children, or the mentally retarded--all groups in whom pica occurs more frequently than the general population. Intestinal obstruction was the most common clinical presentation and the ileum most often the site of obstruction reported at surgery. Perforation with peritonitis was the next most common presentation but three cases of colon perforation were diagnosed only at surgery or postmortem. Mixed pica (paper, plastic bags, cloth, string) seemed more likely to require surgery and to cause perforation. An accurate preoperative diagnosis was made most often when a history of pica was sought, and opacity on abdominal X rays correctly interpreted. These clues to pica as the underlying cause of abdominal complaints should not be neglected in patients who are members of the groups known to be at higher risk of this compulsive eating disorders.