Complicated acute appendicitis associated with sand ingestion due to pica: a case report
DOI:
https://doi.org/10.66636/gmj.v1.i2.a38Keywords:
acute appendicitis, pica, foreign body appendicitis, sand ingestion, geophagy, iron deficiency anemia, case reportAbstract
Background Foreign body appendicitis is an uncommon cause of acute abdomen, accounting for less than 0.001% of all appendicitis cases. Sand ingestion due to pica is a rarely reported etiology. Pica, defined as the persistent consumption of non-nutritive substances, is associated with iron deficiency anemia and may present with serious gastrointestinal complications.
Case presentation A 43-year-old female presented to Leratong Hospital, Johannesburg, South Africa, with a one-day history of lower abdominal pain and vomiting. Examination revealed peritonitis with tachycardia (116 beats per minute). Laboratory findings included hemoglobin 9.5 g/dL, white cell count 11.6 × 10⁹/L, and C-reactive protein 150 mg/L. Abdominal radiography demonstrated diffuse radiopaque material throughout the colon. Laparoscopic appendectomy was converted to open surgery due to equipment failure. Intraoperative findings revealed a perforated appendiceal base with the lumen filled with sand and a sand-laden large bowel causing displacement of the transverse colon into the pelvis. Histopathology confirmed acute appendicitis with peritonitis. Postoperatively, the patient disclosed a five-year history of sand ingestion attributed to pica.
Conclusion This case illustrates that pica-related sand ingestion can result in complicated appendicitis with perforation. Clinicians managing patients with unexplained anemia or radiopaque material on imaging should consider pica as a differential diagnosis and actively inquire about non-nutritive substance ingestion during history-taking.
Keywords acute appendicitis; pica; foreign body appendicitis; sand ingestion; geophagy; iron deficiency anemia; case report
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