Coin pica-induced gastric perforation resulting from ingestion of 1,894 coins, 8 kg in total: case report and review of published works

Posterior Gastric Perforation with an Opening in Transverse Mesocolon: A Rare Case Report

Posterior gastric perforation is a very rare finding, difficult to diagnose due to the insidious onset of upper abdominal symptoms, and no air under the diaphragm on X-ray. Posterior gastric perforation which opens into transverse mesocolon is even rarer. This is a case report done to entail such a rare case, with only two cases reported in the past. We present the case of a 21-year-old female with pain in the epigastric region spreading to involve the whole abdomen, fever, vomiting, and anorexia. In our case, radiological findings revealed pneumoperitoneum. Intraoperatively, a tract was identified between the posterior wall of the stomach and transverse mesocolon. Tract was excised and primary repair was done using the Graham patch method.

Implicit and explicit safety evaluation of foods: The importance of food processing

Identifying beneficial foods in the environment, while avoiding ingesting something toxic, is a crucial task humans face on a daily basis. Here we directly examined adults' implicit and explicit safety evaluations of the same foods presented with different degrees of processing, ranging from unprocessed (raw) to processed (cut or cooked). Moreover, we investigated whether individual characteristics (e.g., Body Mass Index, food neophobia and hunger) modulated their evaluations. We hypothesized that adults would associate the processed form of a food with safety more than its unprocessed form since processing techniques, which are ubiquitously applied in different cultures, often reduce the toxicity of foods, and signal previous human intervention and intended consumption. Adults (N = 109, 43 females) performed an implicit Go/No-Go association task (GNAT) online, assessing the association between safety attributes and food images differing on their degree of processing, both unfamiliar and familiar foods were used. Then each food was explicitly evaluated. Results revealed that individual self-reported characteristics affected both implicit and explicit evaluations. Individuals with excess weight and obesity had a strong and positive implicit association between processed foods and safety attributes, but explicitly rated cooked foods as the least safe overall, this latter result was found in highly neophobic individuals as well. Yet, at the explicit level, when looking at unfamiliar foods only, processed foods were rated safer than unprocessed foods by all participants. Our results are the first evidence that directly highlights the relevance of the degree of processing in food safety evaluation and suggest that thinking of the important tasks humans face regarding food selection enriches our understanding of food behaviors.

Buried coin in the gastric mucosa

A 29-year-old man presented to the Accident and Emergency department with abdominal cramping following ingestion of a 50 p coin 2½ weeks prior to presentation. He had not observed it pass in his stools. An abdominal radiograph confirmed the presence of the 50 p coin in his stomach. Subsequently, he had an oesophagogastroduodenoscopy (OGD) performed with a failure to visualise the coin. 1½ weeks later, he returned to the department as he was still unable to observe its passing in his stools. A repeated abdominal radiograph and a CT of the abdomen and pelvis revealed that the coin was still in his stomach. A second OGD was performed once again with a failure to visualise the coin. It appeared that the coin had migrated into his gastric mucosa.

Pica: A Common Condition that is Commonly Missed - An Update Review

BACKGROUND

Pica is a common condition in childhood that is commonly missed.

OBJECTIVE

To familiarize physicians with the clinical evaluation and management of children with pica.

METHODS

A PubMed search was completed in Clinical Queries using the key term "pica" OR "dirteating". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. Only papers published in English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article.

RESULTS

Pica refers to the persistent, compulsive craving for and the ingestion of substances usually considered inedible and the behavior is discordant with cultural practices and continues beyond the normal developmental phase of occasional indiscriminate and experimental mouthing and swallowing over a period of at least one month. The condition is more common among children in lower socioeconomic classes and those who are mentally handicapped or emotionally deprived. Pica is a significant cause of anemia and lead poisoning. Pica generally resolves in children of normal intelligence after they have been trained to discriminate between edible and inedible items and proper supervision is provided. While relief of family economic and housing difficulties is an adjunct, attention to the individual's emotional needs and stresses is of paramount importance. Children with iron deficiency anemia should be treated with iron replacement therapy. Complications such as gastrointestinal obstruction and lead poisoning should be promptly recognized and treated.

CONCLUSION

Pica is often an overlooked phenomenon and its association with iron deficiency and lead poisoning has been known for centuries. The underlying cause and complications should be treated if possible. Primary care physicians should be aware of pica and proactively seek information about pica in patients that belong to the high-risk groups.