CORRESPON DENCE
Letter to the editor

Pica - a barium
enema look-alike

A 15-month-old baby boy
consumed a substantial amount of
seasand while playing at the beach.
Twelve hours later he presented with
diarrhoea and vomiting and was
referred for an abdominal x-ray.

The supine abdominal radiograph
(Figure 1) demonstrated partial opaci-

fication of the
small bowel, and
almost complete
opacification of
the large bowel so
that the appear-
ance resembled
that of a barium
enema film.
A hernivertebra at
L4 level, with a
scoliosis convex to
the left side, was
also identified.

Geophagia
[the habit of eat-
ing clay, (geo) or
dirt]l is also
known as pica
(the Latin word
for magpie, an
avian scavenger]!
and describes the
phenomenon of
the ingestion of

non-food substances such as clay,plas-
ter and paint and, in this case report,
of seasand. Such dietary habits have

Figure 1: Supine abdominal radiograph demonstrates column of radiopaque
material fl/ling large bowel (and to a lesser degree sma/l bowel) due to ingestion of
dark seasand twelve hours earlier. and not the result of a barium enema. In addition
to pica, note hemivertebra at L, level with scoliosis convex to the left side.

18 SAjOURNAL OF RADIOLOGY. August 1998

been described since antiquity and
persist in many primitive societies
during pregnancy and lactation."

In the paediatric population it oc-
curs mainly during the second year
when the toddler starts getting around,
and it usually does not last beyond age
four or five. A variety of evidence has
associated pica with nutritional defi-
ciency, especially of iron, zinc and cal-
cium. Pica is often seen to some de-
gree in developmentally disabled chil-
dren who are institutionalized. When
the ingested material contains lead or
other toxic material, detrimental or
lethal consequences may ensue.

The appearance in the case re-
ported is unusual, in that a large
amount of seasand was ingested, simu-
lating the features of a barium enema
study, and also because this was not
the more usual white sand, but a dark
seas and (almost black) containing
large amounts of iron and other ele-
ments. The hemivertebra at L4level is
due for further investigation and an
orthopaedic opinion is to be sought.
References
1. Silverman FN, Kuhn lP. Essentials of Caffey's

Pediatric X-ray Diagnosis. Year book Medical
Publishers, Chicago 1990; 633.

2. Levine MD, Carey WB, Crocker AC, Gross RT.
Developmental behavioural pediatrics. w. B.
Saunders, Philadelphia, 1983; 428, 536.

From:

Dr Fred van Ge/deren
FFRad(D)(SA)
Consultant Radio/agist, Taranaki Base Hosipta/, New Zealand