Lithophagia: pebbles in and pebbles out.

Fig. 1 : X-ray abdomen of the patient showing pebbles in rectum and the anal canal 35 year old male patient hailing from Sivani, madhya Pradesh had come with complaints of passing watery stools, dull aching pain in the abdomen since 10 to 15 days. Patient had been a case of mental retardation since childhood. he was noticed passing pebbles along with passage of watery stools. On further enquiry it was found that patient had been consuming pebbles since childhood. Systemic examination was normal. Investigations revealed normocytic, normochromic anemia (hb 9g%), TLc -10,000/cumm and normal kidney and liver function tests. Patient’s USG abdomen was normal however X-ray plain abdomen and cT abdomen revealed multiple hyperdense round to oval structures of average size 7 mm involving descending colon, sigmoid colon and rectum with intraabdominal lymphadenopathy (Fig. 1). Patient’s loose stools got controlled however he continued passing of pebbles. Patient could not be operated in view of absence of complications. Patient was started on antipsychotic medication following which consumption of pebbles was controlled. Geophagia is a habit of eating earth, soil or clay.1 Lithophagia is a subset of geophagia and is a habit of eating pebbles or rocks.2 It is known to be associated with iron deficiency anemia, mentally handicapped, pregnancy and OCDs. The complications include diarrhea,3 electrolyte, disturbances,4 parasitic infections, intestinal obstructions, colonic perforations, myopathy and even increased risk of Alzheimer’s disease.