Pica in the mentally handicapped: a 15-year surgical perspective.

OBJECTIVE

To review the general surgical management of mentally handicapped persons with pica.

DESIGN

A study of hospital records and a review of the current literature.

SETTING

A community hospital.

PATIENTS: Thirty-five patients from a large institution for the mentally handicapped were treated for well-documented pica on 56 occasions at the Orillia Soldiers Memorial Hospital between 1976 and 1991.

INTERVENTIONS: Endoscopy and laparotomy for the removal of foreign bodies or to close perforations.

RESULTS

Fourteen (25%) cases of pica were managed by observation only, but 42 (75%) cases required surgical intervention. There were 34 laparotomies. The complication rate was 30% and the death rate 11%.

CONCLUSIONS

Pica is a serious health risk for mentally handicapped patients. Diagnosis and postoperative care can be difficult. Pica should be suspected in mentally handicapped patients with gastrointestinal symptoms.