BMJ Case Reports 2017; doi:10.1136/bcr-2017-221066
  • Images in…

Pica, constipation and cardiorespiratory arrest

  1. Armindo Ramos4
  1. 1Department of Internal Medicine, Hospital de Egas Moniz, Lisboa, Portugal
  2. 2Department of Medicine, Hospital de Cascais Dr José de Almeida, Alcabideche, Cascais, Portugal
  3. 3Intensive Care Unit, Hospital de Cascais Dr. José de Almeida, Alcabideche, Cascais, Lisboa, Portugal
  4. 4Intensive Care Unit Director, Hospital de Cascais Dr. José de Almeida, Alcabideche, Cascais, Lisboa, Portugal
  1. Correspondence to Dr Inês Mourato Nunes, inesmouratonunes{at}
  • Accepted 8 June 2017
  • Published 14 July 2017


Pica is an eating disorder typically defined as the persistent ingestion of non-nutritive substances, for at least 1 month, at an age of which this behaviour is inappropriate. It may be benign or may have life-threatening consequences.1 2 The clinical presentation is highly variable and is associated with the specific nature of the resulting medical conditions and the ingested substances. The signs and symptoms can be from toxic, infectious, dental or gastrointestinal conditions.3

The authors present a clinical case of a 61-year-old man with clinical history of cognitive impairment and pica, admitted in an intensive care unit after cardiorespiratory arrest. The initial hospital admission was for constipation and abdominal pain. Abdominal and pelvic CT scan revealed ‘significant colonic dilatation with a sigmoid size of 14.5 cm, with evidence of abundant intraluminal faecal content at this level—aspects suggestive of translating obstructive process by faecaloma, visualising bone and metallic contents inside’. A rectal touch was performed with extraction of abundant faeces and foreign bodies (bones and screws). After abundant excretion, he had bradycardia with haemodynamic instability and altered state of consciousness, culminating in cardiorespiratory arrest in asystolia and subsequently ventricular fibrillation with recovery after advanced life support. The patient was submitted to colonic transversostomy with improvement of the condition.

These are striking images, the consequence of an often benign disorder that may have the most tragic outcome (figures 1–3).

Figure 1

CT scan—sagittal plane—marked colic dilatation with rectum foreign bodies.

Figure 2

CT scan—coronal plane—dilated rectum with foreign bodies inside.

Figure 3

CT scan—transversal plane—dilated rectum with bones/screws inside.

Learning points

  • Pica is a dangerous form of self-injuries behaviour that occurs in people with developmental disabilities who are institutionalised.

  • Remember that gastrointestinal complications associated with pica range from mild (eg, constipation) to life-threatening conditions (eg, perforations or ulcerations).


  • Contributors IMN: conception and design, acquisition of data; drafting the article. AIP: acquisition of data. MI, AR: revising it critically for important intellectual content; final approval of the version published.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.


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