Forensic Science, Medicine and Pathology

, Volume 15, Issue 4, pp 598–602 | Cite as

A complicated case of bowel obstruction with sepsis and methamphetamine toxicity in a child with pica

  • Christine StevensEmail author
  • Erinn Ton
  • Prentiss Jones
  • Brandy Shattuck
Case Report


In this report, a pediatric case of bowel obstruction with sepsis complicated by methamphetamine toxicity is described. The decedent, an eleven-year-old female with a clinical history of pica, was found unresponsive in her home and pronounced dead following unsuccessful resuscitative efforts. Radiologic imaging showed multiple radio-opaque foreign objects in the stomach and bowel. Autopsy revealed a green leafy substance, coins and other metallic items, folded paper, and plastic in her stomach and bowels. Postmortem iliac blood and urine tested positive for amphetamine and methamphetamine. While the decedent’s medical history and autopsy findings provided evidence consistent with bowel obstruction with sepsis due to the ingestion of foreign materials, the high methamphetamine concentration was suggestive of concurrent methamphetamine toxicity. Unique complications associated with this case include the phenomenon that methamphetamine toxicity and bowel obstruction can present similarly in children and the reported opinion that accidental drug ingestion is uncommon in children over the age of five. This case emphasizes that the age range for suspected accidental drug ingestion should be expanded for those with pica, as these patients, despite being older, may not be able to differentiate between what they should and should not ingest. Furthermore, when treating a pediatric patient with pica that appears to present with bowel obstruction, unintentional drug ingestion should also be considered, particularly if there is a suspicion that the child lives in a household where drugs are abused, given the prospect that drug toxicity can present similarly.


Pica Pediatric methamphetamine Accidental overdose Adolescent methamphetamine Pediatric bowel obstruction Pediatric sepsis 


Compliance with ethical standards

The authors individually declare that to the best of their knowledge and belief, a relationship, financial or otherwise does not exist which represents or may be perceived as representing a conflict of interest regarding the submitted manuscript. This manuscript does not contain any studies with human or animal subjects.




  1. 1.
    Hunt D, Kuck S, Truitt L. Methamphetamine use: lessons learned. Cambridge: Abt Associates Inc; 2005.Google Scholar
  2. 2.
    Galbraith N. The methamphetamine problem. Bjpsych Bulletin. 2015;39:218–20.CrossRefGoogle Scholar
  3. 3.
    Vearrier D, Greenberg MI, Miller SN, Okaneku JT, Haggerty DA. Methamphetamine: history, pathophysiology, adverse health effects, current trends, and hazards associated with the clandestine manufacture of methamphetamine. Dis Mon. 2012;58:38–89.CrossRefGoogle Scholar
  4. 4.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.CrossRefGoogle Scholar
  5. 5.
    Rose E, Porcerelli J, Neale A. Pica: common but commonly missed. J Am Board Fam Pract. 2000;13:353–8.PubMedGoogle Scholar
  6. 6.
    Hartmann AS, Poulain T, Vogel M, et al. Prevalence of pica and rumination behaviours in German children aged 7-14 and their associations with feeding, eating, and general psychopathology: a population-based study. Eur Child Adolesc Psychiatry. 2018.
  7. 7.
    Castaneto M, Barnes A, Scheidweiler K, Schaffer M, Rogers K, Stewart D, et al. Identifying methamphetamine exposure in children. Ther Drug Monit. 2013;35:823–30.CrossRefGoogle Scholar
  8. 8.
    Gould MS, et al. Sudden death and use of stimulant medications in youths. Am J Psych. 2009;166:992–1001.CrossRefGoogle Scholar
  9. 9.
    Barnard M, McKeganey N. The impact of parental problem drug use on children: what is the problem and what can be done to help? Addiction. 2004;99:552–9.CrossRefGoogle Scholar
  10. 10.
    Ibrahim A. Pica in children with tetralogy of Fallot: report of two cases. Muller J Med Sci Res. 2013;4:122–3.CrossRefGoogle Scholar
  11. 11.
    Mehra A, Sharma N, Grover S. Pagophagia in a female with recurrent depressive disorder: a case report with review of literature. Turk Psikiyatri Derg. 2018;29:143–5.PubMedGoogle Scholar
  12. 12.
    Kolecki P. Inadvertent methamphetamine poisoning in pediatric patients. Pediatr Emerg Care. 1998;14:385–7.CrossRefGoogle Scholar
  13. 13.
    Hajivassiliou C. Intestinal obstruction in neonatal/pediatric surgery. Semin Pediatr Surg. 2003;12:241–53.CrossRefGoogle Scholar
  14. 14.
    Rami Reddy SR, Cappell MS. A systematic review of the clinical presentation, diagnosis, and treatment of small bowel obstruction. Curr Gastroenterol Rep. 2017;19:28.CrossRefGoogle Scholar
  15. 15.
    Byard RW. A review of the forensic implications of pica. J Forensic Sci. 2014;59:1413–6.CrossRefGoogle Scholar
  16. 16.
    Davis LA. Et. al. American college of critical care medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. Crit Care Med. 2017;45:1061–93.CrossRefGoogle Scholar
  17. 17.
    Gummin DD, Mowry JB, Spyker DA, Brooks DE, Fraser MO, Banner W. 2016 annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 34th annual report. Clin Toxicol. 2017;55(10).Google Scholar
  18. 18.
    Winek CL, Wahba WW, Winek CL Jr, Balzer TW. Drug and chemical blood-level data 2001. Forensic Sci Int. 2001;122:107–23.CrossRefGoogle Scholar
  19. 19.
    De la Burdé B, Reames B. Prevention of pica, the major cause of lead poisoning in children. Am J Public Health. 1973;63:737–43.CrossRefGoogle Scholar
  20. 20.
    Gallacher JE, Elwood PC, Phillips KM, Davies BE, Jones DT. Relation between pica and blood lead in areas of differing lead exposure. Arch Dis Child. 1984;59:40–4.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Western Michigan University Homer Stryker M.D. School of MedicineKalamazooUSA

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