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.