Saudi Journal of Kidney Diseases and Transplantation

LETTER TO THE EDITOR
Year
: 2013  |  Volume : 24  |  Issue : 4  |  Page : 798--799

Geophagia masquerading as urolithiasis


Anuruddha M Abeygunasekera1, Gamini Jayawardena2, P. H. C. Jayathilake1,  
1 Department of Urology, Karapitiya Teaching Hospital, Galle, Sri Lanka
2 Department of Psychiatry, Karapitiya Teaching Hospital, Galle, Sri Lanka

Correspondence Address:
Anuruddha M Abeygunasekera
Department of Urology, Karapitiya Teaching Hospital, Galle
Sri Lanka




How to cite this article:
Abeygunasekera AM, Jayawardena G, Jayathilake P. Geophagia masquerading as urolithiasis.Saudi J Kidney Dis Transpl 2013;24:798-799


How to cite this URL:
Abeygunasekera AM, Jayawardena G, Jayathilake P. Geophagia masquerading as urolithiasis. Saudi J Kidney Dis Transpl [serial online] 2013 [cited 2019 Nov 14 ];24:798-799
Available from: http://www.sjkdt.org/text.asp?2013/24/4/798/113895


Full Text

To the Editor ,

Geophagia is defined as deliberate consumption of earth, soil or clay. From ancient times, it is regarded as a psychiatric disease, a culturally sanctioned practice or a squeal of poverty and famine. [1] From a psychiatric point of view, geophagia is regarded as a form of pica. Geophagia is common in children with learning disabilities, particularly among those institutionalized on a long-term basis. [2] It is also seen during pregnancy and as a feature of iron deficiency anemia. With poverty and famine, the earth may act as an appetite suppressant. In South Africa, some people believe that earth eating may give a more attractive color and texture to their skin. Because of social stigma, many people do not divulge the habit to their doctors. Swallowed stones may cause intestinal obstruction, perforation and peritonitis. [3],[4]

A 17-year-old school girl was admitted to the hospital with abdominal pain. She was an average student in the class, with no learning disability. She had two younger siblings and was from a low-middle class family living in an urban area. The abdominal examination did not reveal any signs and the X-ray KUB showed three opacities in the abdomen, suggestive of a stone in the right kidney and two stones in the lower part of the right ureter [Figure 1]. A diagnosis of renal and ureteric stones was made and urological opinion was sought. The opacities had an atypical distribution as the one intended to be in the lower end of the right ureter was too high up in the X-ray KUB. The outline of the opacities was too irregular and deformed to be urinary stones. Therefore, the possibility of stones in the small intestine was thought of and an abdominal ultrasonography revealed a normal urinary tract. Another X-ray obtained 24 h later showed rapid change in the position of the stones, confirming the presence of stones in the intestines [Figure 2]. A psychiatric assessment did not reveal any evidence of a major psychiatric disorder. Three days later, the X-ray was normal. When reviewed six months later, she was free of abdominal pain or repetition of geophagia.{Figure 1}{Figure 2}

In this patient, geophagia was not associated with features of a major psychiatric disorder. There was no associated material gain to suggest malingering. By swallowing stones, the patient has shown a bizarre behavior probably in a stressful situation, suggesting the possibility of a fictitious disorder. She did not develop clinical features of intestinal obstruction or perforation. As she remained well thereafter with no repetition of geophagia, a behavioral intervention was unnecessary. Medical personnel should be aware of the possibility of geophagia in patients with opacities with an atypical distribution in their abdominal X-rays. Otherwise, patients may be subjected to unnecessary investigations and delay. The opacities due to swallowed stones are of varying sizes and densities. Those with a fictitious disorder do not display major psychiatric or learning disability, and the diagnosis may be missed if not associated with a high index of suspicion. Serial radiography will clinch the diagnosis easily as stones in the intestines change in position rapidly with time.

References

1Woywodt Alexander, Kiss Akos. Geophagia: The history of earth-eating. J R Soc Med 2002;95:143-6.
2Parry-Jones B, Parry-Jones WL. Pica: Symptom or eating disorder? A historical assessment. Br J Psychiatry 1992;160:341-54.
3Hawass NE, Alnozha MM, Kolawole T. Adult geophagia - report of three cases with review of the literature. Trop Geog Med 1987;39:191-5.
4Sevour F, Witzling M, Frenkel-Lanfer D, Gorenstein A. Intestinal obstruction in an autistic adolescent. Paediatr Emerg Care 2008; 24:688-90